{"hospital_name":"Mary Rutan Hospital","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Mary Rutan Hospital"],"hospital_address":["205 Palmer Avenue, Bellefontaine, OH 43311"],"license_information":{"license_number":"360197","state":"OH"},"type_2_npi":["1548254931"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"David Kelly"},"modifier_information":[{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes","code":"TB","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Administered subcutaneously","code":"JB","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System","code":"95","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left main coronary artery","code":"LM","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left anterior descending coronary artery","code":"LD","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left circumflex coronary artery","code":"LC","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right coronary artery","code":"RC","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Ramus intermedius coronary artery","code":"RI","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","code":"CQ","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant","code":"CO","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Clinical Diagnostic Laboratory Test","code":"91","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Waiver of liability statement issued as required by payer policy, individual case","code":"GA","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedBen","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"SuperMed HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"MediGold","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"OhioHealthy","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quality Care Partners","plan_name":"Steered PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Ohio Rise Better Health Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathways PPO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Aetna 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Entire Spi 1 Vw","code_information":[{"code":"712606","type":"CDM"},{"code":"320","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Lumbar Spine 4+ Vws","code_information":[{"code":"712611","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":752.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Humerus 2 Vws  Unil","code_information":[{"code":"712621","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":443.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Forearm 2 Vws","code_information":[{"code":"712624","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":443.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Wrist 2 Vws Unil","code_information":[{"code":"712625","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":443.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Wrist 2 Vws Bilat","code_information":[{"code":"712626","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":545.6,"setting":"both","modifier_code":["TC50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Hand 2 Vws Unil","code_information":[{"code":"712628","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":443.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"Xray Hip Unil W Pelvis 1Vws","code_information":[{"code":"712632","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Hip Unila W Pelvis 2-3Vws","code_information":[{"code":"712633","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":480.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"Xray Ankle 2 Vws","code_information":[{"code":"712647","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Ankle 3 Or > Vws","code_information":[{"code":"712649","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Bilat Ankle 3 View","code_information":[{"code":"712650","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":571.2,"setting":"both","modifier_code":["TC50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"Xray Foot 2 Vws","code_information":[{"code":"712651","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Bilat Foot 2 Vws","code_information":[{"code":"712652","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":597.6,"setting":"both","modifier_code":["TC50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"Xray Foot 3 Or > Vws","code_information":[{"code":"712653","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Bilat Foot 3 View","code_information":[{"code":"712654","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":574.4,"setting":"both","modifier_code":["TC50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"Xray Calcaneous Heel 2 Vws","code_information":[{"code":"712655","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Toes 2 Vws","code_information":[{"code":"712656","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Chest 1 View","code_information":[{"code":"712657","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.5,"discounted_cash":131.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: CORP | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":540.0,"discounted_cash":432.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Chest 2 Vws","code_information":[{"code":"712658","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":104.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: CORP | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":595.0,"discounted_cash":476.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Chest 3 Vws","code_information":[{"code":"712659","type":"CDM"},{"code":"320","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":458.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Chest 4 Or > Vws","code_information":[{"code":"712660","type":"CDM"},{"code":"320","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":590.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Abdomen 1 View","code_information":[{"code":"712661","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":428.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Abdomen 2 Vws","code_information":[{"code":"712662","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":515.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Abdomen 3 Or > View2","code_information":[{"code":"712663","type":"CDM"},{"code":"320","type":"RC"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":359.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Eye For Foreign Body","code_information":[{"code":"712664","type":"CDM"},{"code":"320","type":"RC"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":428.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Jaw Compl Min 4 Vws","code_information":[{"code":"712665","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":641.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Facial Bones Min 3 Vws","code_information":[{"code":"712666","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.0,"discounted_cash":917.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Nasal Bones Min 3 Vws","code_information":[{"code":"712667","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":687.0,"discounted_cash":549.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Exam Of Eye Sockets","code_information":[{"code":"712668","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":556.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Of Skull Min 4 Vws","code_information":[{"code":"712672","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":735.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Jaw Joints Both Sides Fac","code_information":[{"code":"712673","type":"CDM"},{"code":"320","type":"RC"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Of Neck Soft Tissue","code_information":[{"code":"712674","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":428.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Ribs Unileral 2 Vws","code_information":[{"code":"712675","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":443.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Ribs Bilat 3 Vws","code_information":[{"code":"712676","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":693.6,"setting":"both","modifier_code":["TC50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"Xray Breastbone Min 2 View","code_information":[{"code":"712677","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Strenoclavic Jt Min 3 Vws","code_information":[{"code":"712678","type":"CDM"},{"code":"320","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":391.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Exam Neck Spine 6 Or > Vw","code_information":[{"code":"712679","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1229.0,"discounted_cash":983.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Thorac Spine Min 4 Vws","code_information":[{"code":"712680","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.0,"discounted_cash":917.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Sacrum Coccyx Min 2Vws","code_information":[{"code":"712683","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":435.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Scapula Complete","code_information":[{"code":"712684","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray A-C Joints Bi W/Wo Weight","code_information":[{"code":"712685","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":443.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Upr Ext Inf Min 2 Vws Bil","code_information":[{"code":"712687","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":834.4,"setting":"both","modifier_code":["TC50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"Xray Finger(S) Min 2 Vws","code_information":[{"code":"712688","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":489.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Lwr Ext Inf Min 2 Vws Uni","code_information":[{"code":"712689","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":443.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Lwr Ext Inf Min 2 Vws Bil","code_information":[{"code":"712690","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":703.0,"discounted_cash":562.4,"setting":"both","modifier_code":["TC50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"Xray Abd Comp Ser W/S/E/D & Ch","code_information":[{"code":"712691","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.0,"discounted_cash":804.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Nose To Rectum For Fb Chi","code_information":[{"code":"712692","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":420.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Xray Knee Bil","code_information":[{"code":"712693","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":1347.0,"discounted_cash":1077.6,"setting":"both","modifier_code":["TC50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"Xray Cspine Or Less","code_information":[{"code":"712694","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":444.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70440.49,"maximum":243407.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":131065.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127320.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":243407.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":243407.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":213449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70440.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74894.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86444.16,"maximum":305724.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":164620.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159917.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":305724.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":305724.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":268096.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86444.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94069.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52123.64,"maximum":169401.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":91216.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88610.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":169401.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":169401.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":148552.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52738.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52123.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39924.83,"maximum":139986.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":75377.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73223.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":139986.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":139986.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":122757.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39924.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43072.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37736.59,"maximum":135279.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":72842.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70761.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":135279.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":135279.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":118629.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37736.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41624.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29582.28,"maximum":107337.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":57796.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56145.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":107337.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":107337.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":94126.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29582.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33026.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40213.25,"maximum":141842.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":76376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74194.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":141842.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":141842.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":124384.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40213.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43643.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14719.7,"maximum":51823.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":27905.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27107.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":51823.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":51823.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45445.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14719.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14126.33,"maximum":50308.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":27088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26314.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":50308.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":50308.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":44116.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14126.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25722.43,"maximum":91378.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":49203.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47797.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":91378.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":91378.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":80131.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25722.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28116.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15046.48,"maximum":56434.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":30387.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29519.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":56434.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":56434.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49488.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15046.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17364.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21966.43,"maximum":77718.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":41848.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40652.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":77718.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":77718.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":68153.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21966.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11625.86,"maximum":40787.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21962.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21334.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":40787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":40787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35767.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11625.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6094.4,"maximum":23116.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12447.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12091.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23116.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23116.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20271.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6094.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9916.55,"maximum":36046.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19409.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18855.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36046.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36046.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31610.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9916.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11091.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7216.3,"maximum":24070.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12960.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12590.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21107.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7216.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16563.96,"maximum":54843.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":29530.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28687.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":54843.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":54843.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":48093.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16563.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13688.58,"10th_percentile":13688.58,"90th_percentile":13688.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12209.31,"maximum":40357.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21730.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21110.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":40357.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":40357.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35390.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12209.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5903.23,"maximum":21714.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11692.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11358.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19041.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5903.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9292.09,"maximum":33140.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17844.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17335.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33140.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33140.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29061.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9292.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13157.9,"maximum":47475.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":25563.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24833.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":47475.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47475.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41632.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13157.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6727.46,"maximum":23850.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12842.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12475.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23850.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23850.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20915.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6727.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11292.23,"10th_percentile":11292.23,"90th_percentile":11292.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9871.83,"10th_percentile":9871.83,"90th_percentile":9871.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6478.59,"10th_percentile":6478.59,"90th_percentile":6478.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4553.1,"maximum":16157.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8699.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8451.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16157.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16157.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4553.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9630.12,"maximum":34672.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18669.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18136.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":34672.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34672.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30405.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9630.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5831.78,"maximum":20406.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10674.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20406.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20406.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17894.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5831.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5293.32,"maximum":18857.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9864.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18857.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18857.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16536.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5293.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8884.78,"10th_percentile":8884.78,"90th_percentile":8884.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11501.5,"maximum":39302.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21162.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20558.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39302.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39302.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34464.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11501.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6970.89,"maximum":24221.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13042.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12669.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24221.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24221.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6970.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11703.11,"10th_percentile":11703.11,"90th_percentile":11703.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4961.91,"maximum":17852.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9612.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9338.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":17852.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17852.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15654.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4961.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6895.48,"maximum":24334.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13103.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12728.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24334.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24334.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21339.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6895.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5994.18,"maximum":19481.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10489.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10190.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19481.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19481.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17083.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6065.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10228.11,"maximum":10228.11,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10228.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6600.45,"maximum":6600.45,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6600.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10298.03,"10th_percentile":10298.03,"90th_percentile":10298.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4410.22,"maximum":4410.22,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4410.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15347.46,"maximum":53957.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":29054.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28224.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":53957.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":53957.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47316.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15347.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6323.94,"maximum":22564.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12149.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19787.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6323.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8676.23,"maximum":30753.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16559.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16086.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":30753.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30753.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26968.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8676.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7091.94,"maximum":25935.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13965.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13566.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25935.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25935.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22743.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7091.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12057.82,"maximum":41459.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22324.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21686.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":41459.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41459.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36357.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12057.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12756.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7003.96,"maximum":24150.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13004.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12632.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24150.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24150.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21178.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7003.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22192.24,"10th_percentile":22192.24,"90th_percentile":22192.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5221.22,"maximum":18798.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10122.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9833.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18798.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18798.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16485.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5221.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15856.16,"maximum":60889.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":32786.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31849.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":60889.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":60889.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":53394.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15856.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18735.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14348.6,"maximum":54177.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":29172.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28338.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":54177.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":54177.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47509.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14348.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9216.02,"maximum":32163.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17318.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16823.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":32163.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32163.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28204.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9216.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13132.1,"maximum":45723.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23916.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":45723.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45723.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":40095.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13132.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9883.75,"10th_percentile":9883.75,"90th_percentile":9883.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6097.05,"10th_percentile":6097.05,"90th_percentile":6097.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7669.43,"maximum":26461.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14248.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13841.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":26461.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26461.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23205.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7669.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5624.07,"maximum":19743.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10630.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10327.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19743.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19743.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17313.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5624.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2624.4,"10th_percentile":2624.4,"90th_percentile":2624.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7819.59,"maximum":31941.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17199.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16707.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31941.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31941.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28010.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7819.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10126.9,"maximum":36235.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19511.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18953.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36235.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36235.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31775.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10126.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11037.13,"maximum":42685.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22984.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22327.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":42685.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42685.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37431.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11037.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4486.95,"maximum":18550.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9988.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9703.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18550.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18550.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16267.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4486.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8624.64,"maximum":31235.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16819.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16338.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31235.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31235.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27391.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8624.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15762.68,"maximum":51228.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":27584.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26796.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":51228.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":51228.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":44923.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15948.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5381.3,"maximum":20921.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11265.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10943.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20921.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20921.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18346.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5381.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27974.84,"maximum":100693.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":54219.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52670.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":100693.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":100693.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":88300.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27974.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30982.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10400.76,"maximum":37687.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20293.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19713.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":37687.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37687.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33048.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10400.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7836.79,"maximum":28383.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15283.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14846.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":28383.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28383.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24890.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7836.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8233.69,"maximum":30017.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16163.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15701.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":30017.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30017.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26322.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8233.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9236.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":17497.16,"10th_percentile":17497.16,"90th_percentile":17497.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7506.04,"maximum":27909.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15027.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14598.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":27909.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27909.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24474.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7506.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12501.2,"10th_percentile":12501.2,"90th_percentile":12501.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10757.31,"maximum":36910.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19874.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19307.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36910.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36910.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32367.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10757.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4447.93,"maximum":16315.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8785.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8534.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16315.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16315.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14307.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4447.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4363.25,"maximum":16726.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9006.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8749.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16726.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16726.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14667.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4363.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16648.63,"maximum":59585.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":32084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31167.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":59585.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":59585.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":52252.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16648.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25474.37,"maximum":88238.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":47513.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46155.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":88238.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":88238.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":77378.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25474.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27150.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20297.47,"maximum":70265.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":37835.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36754.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":70265.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":70265.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":61617.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20297.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9321.2,"maximum":32427.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17460.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16962.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":32427.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32427.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28436.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9321.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9977.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4762.08,"10th_percentile":4762.08,"90th_percentile":4762.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14600.8,"10th_percentile":14600.8,"90th_percentile":14600.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13880.5,"10th_percentile":13880.5,"90th_percentile":13880.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5387.92,"maximum":19004.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10233.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9940.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19004.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19004.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16665.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5387.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5847.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8945.89,"10th_percentile":8945.89,"90th_percentile":8945.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":9830.58,"10th_percentile":9830.58,"90th_percentile":9830.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10693.15,"maximum":36891.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19864.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19297.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36891.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36891.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32351.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10693.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17947.09,"10th_percentile":17947.09,"90th_percentile":17950.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":10144.69,"10th_percentile":10144.69,"90th_percentile":10144.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16000.42,"10th_percentile":16000.42,"90th_percentile":16000.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":14988.42,"10th_percentile":14988.42,"90th_percentile":14988.42},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17279.61,"10th_percentile":17279.61,"90th_percentile":17279.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10677.41,"10th_percentile":10677.41,"90th_percentile":10677.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16113.43,"10th_percentile":16113.43,"90th_percentile":16113.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5364.1,"maximum":19060.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10263.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9970.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19060.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19060.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16714.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5364.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4606.02,"maximum":15817.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8516.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8273.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":15817.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15817.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13870.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4606.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6394.72,"maximum":22927.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12345.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11993.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22927.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22927.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20105.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6394.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7735.14,"10th_percentile":7735.14,"90th_percentile":7735.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":8344.4,"10th_percentile":8344.4,"90th_percentile":8344.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3875.82,"10th_percentile":3875.82,"90th_percentile":3875.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":6927.23,"10th_percentile":6927.23,"90th_percentile":6927.23},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10559.36,"10th_percentile":10559.36,"90th_percentile":10559.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4477.69,"maximum":16881.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9090.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8830.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16881.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16881.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14804.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4477.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4319.72,"10th_percentile":4319.72,"90th_percentile":4319.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7325.45,"maximum":25951.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13974.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13574.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25951.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25951.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22757.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7325.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11676.8,"maximum":41646.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22424.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21784.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":41646.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41646.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36520.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11676.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19568.34,"10th_percentile":19568.34,"90th_percentile":19568.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4633.15,"maximum":16907.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9104.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8844.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16907.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16907.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14826.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4633.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6548.19,"maximum":22406.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12064.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11720.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22406.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22406.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19648.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6548.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12463.98,"maximum":44552.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":23989.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23304.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":44552.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":44552.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39069.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12463.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4119.82,"maximum":14837.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":7989.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7761.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":14837.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14837.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13011.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4119.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6924.59,"10th_percentile":6924.59,"90th_percentile":6924.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5872.1,"10th_percentile":5872.1,"90th_percentile":5872.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4119.16,"10th_percentile":4119.16,"90th_percentile":4119.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":16802.84,"10th_percentile":16802.84,"90th_percentile":16802.84},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4559.94,"10th_percentile":4559.94,"90th_percentile":4559.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2114.81,"10th_percentile":2114.81,"90th_percentile":2114.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8717.25,"maximum":31029.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16708.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16231.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31029.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31029.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27210.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8717.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14000.59,"10th_percentile":6909.19,"90th_percentile":14632.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4474.43,"10th_percentile":4474.43,"90th_percentile":4474.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14654.81,"10th_percentile":14654.81,"90th_percentile":14654.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4563.93,"10th_percentile":4563.93,"90th_percentile":4563.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8716.59,"10th_percentile":7844.93,"90th_percentile":8716.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":12866.39,"10th_percentile":6909.2,"90th_percentile":13600.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4281.23,"maximum":15156.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8161.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7927.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":15156.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15156.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13290.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4281.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6808.63,"10th_percentile":6808.63,"90th_percentile":6838.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":9988.88,"10th_percentile":9988.88,"90th_percentile":9988.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":8394.95,"10th_percentile":8394.95,"90th_percentile":8394.95},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6746.02,"10th_percentile":6746.02,"90th_percentile":6746.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5682.95,"maximum":19901.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10716.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10409.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19901.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19901.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17451.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5682.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7459.46,"10th_percentile":7459.46,"90th_percentile":7459.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8481.97,"10th_percentile":8481.97,"90th_percentile":8481.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4129.26,"10th_percentile":4129.26,"90th_percentile":4129.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8973.56,"10th_percentile":8973.56,"90th_percentile":8973.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9248.84,"10th_percentile":7777.98,"90th_percentile":9635.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7430.63,"maximum":26150.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14080.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13678.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":26150.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26150.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22931.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7430.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12391.57,"10th_percentile":12391.57,"90th_percentile":12391.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12460.28,"10th_percentile":12095.32,"90th_percentile":12460.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":11177.02,"10th_percentile":11177.02,"90th_percentile":11177.02},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4693.66,"10th_percentile":4693.66,"90th_percentile":4693.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6228.34,"10th_percentile":6228.34,"90th_percentile":6228.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10706.08,"10th_percentile":10320.61,"90th_percentile":10820.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8186.06,"maximum":29164.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15704.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15255.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":29164.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29164.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25575.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8186.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13129.2,"10th_percentile":11753.91,"90th_percentile":13546.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5740.94,"10th_percentile":5740.94,"90th_percentile":5740.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20660.75,"10th_percentile":20660.75,"90th_percentile":20660.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8185.4,"10th_percentile":8185.4,"90th_percentile":8185.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12259.6,"10th_percentile":12259.6,"90th_percentile":13746.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4856.07,"maximum":16931.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9116.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16931.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16931.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14847.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4856.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6640.8,"maximum":23350.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12573.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12214.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23350.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23350.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20476.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6640.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10451.7,"maximum":36792.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19811.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19245.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36792.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36792.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32264.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10451.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1665.02,"10th_percentile":1665.02,"90th_percentile":1665.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5143.82,"maximum":18567.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9997.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9712.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18567.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18567.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16282.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5143.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7064.82,"maximum":25120.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13526.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13140.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25120.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25120.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22029.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7064.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10381.13,"10th_percentile":10381.13,"90th_percentile":10381.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10499.33,"maximum":36117.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19447.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18892.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36117.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36117.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31672.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10499.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5475.53,"maximum":17795.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9582.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":17795.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17795.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15605.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5540.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7343.97,"maximum":25283.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13614.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13225.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25283.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25283.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22172.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7343.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6786.03,"10th_percentile":6786.03,"90th_percentile":6786.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6562.74,"maximum":23041.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12052.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23041.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23041.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20205.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6562.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":14888.69,"10th_percentile":14888.69,"90th_percentile":14888.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7801.54,"10th_percentile":7801.54,"90th_percentile":7801.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11024.95,"10th_percentile":11024.95,"90th_percentile":11024.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40973.31,"maximum":141802.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":76354.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74173.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":141802.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":141802.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":124349.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40973.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43631.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25864.65,"maximum":97393.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":52442.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50944.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":97393.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":97393.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":85406.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25864.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22784.71,"maximum":83956.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":45207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43915.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":83956.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":83956.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":73623.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22784.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25832.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33953.47,"maximum":124561.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":67071.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65155.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":124561.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":124561.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":109230.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33953.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38326.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27521.05,"maximum":99700.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":53684.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":99700.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":99700.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":87429.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27521.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30676.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39626.5,"maximum":144677.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":77903.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75677.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":144677.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":144677.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":126871.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39626.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44516.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23118.76,"maximum":78863.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":42465.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41251.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":78863.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":78863.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":69157.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23118.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24265.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17740.77,"maximum":72178.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":38865.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37754.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":72178.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":72178.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":63294.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17740.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22208.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10039.59,"maximum":38478.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20127.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":38478.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":38478.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33742.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10039.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20004.46,"10th_percentile":20004.46,"90th_percentile":20004.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11626.52,"maximum":47737.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":25704.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24970.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":47737.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47737.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41861.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11626.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14688.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22690.77,"maximum":82350.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":44342.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43075.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":82350.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":82350.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":72215.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22690.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25338.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15298.51,"maximum":51523.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":27743.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26950.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":51523.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":51523.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15298.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":13061.72,"10th_percentile":13061.72,"90th_percentile":13061.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16931.18,"10th_percentile":16931.18,"90th_percentile":16931.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4797.86,"maximum":17172.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9246.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8982.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":17172.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17172.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15058.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4797.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6808.82,"maximum":24103.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12978.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12607.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24103.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24103.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21136.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6808.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10646.43,"10th_percentile":10646.43,"90th_percentile":10646.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11565.0,"maximum":41858.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22539.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21895.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":41858.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41858.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36706.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11565.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13654.03,"10th_percentile":13654.03,"90th_percentile":13654.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4616.61,"maximum":16544.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8908.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8653.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16544.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16544.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14508.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4616.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6731.42,"maximum":23612.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12714.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12351.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23612.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23612.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20706.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6731.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8963.33,"maximum":33001.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17769.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17262.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33001.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33001.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28939.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8963.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28215.62,"maximum":103703.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":55840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54245.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":103703.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":103703.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":90940.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28215.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9953.59,"maximum":35989.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19379.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18825.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":35989.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35989.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31560.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9953.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5827.15,"maximum":20552.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11066.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10750.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20552.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20552.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18023.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5827.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15655.06,"maximum":54193.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":29181.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28347.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":54193.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":54193.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47523.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15655.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17823.46,"maximum":60974.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":32832.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31894.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":60974.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":60974.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":53469.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17823.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18761.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13973.53,"maximum":49781.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26805.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26039.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43654.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13973.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13094.18,"10th_percentile":13094.18,"90th_percentile":13094.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23972.1,"maximum":84300.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":45392.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44095.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":84300.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":84300.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":73925.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23972.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25938.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10970.32,"maximum":38667.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20820.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20225.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":38667.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":38667.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33908.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10970.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10921.37,"maximum":39729.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21392.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20781.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39729.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39729.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34839.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10921.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18332.73,"10th_percentile":18332.73,"90th_percentile":18332.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":47425.45,"10th_percentile":47425.45,"90th_percentile":47425.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15635.88,"maximum":56592.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":30472.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29602.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":56592.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":56592.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49627.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15635.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26242.3,"10th_percentile":26242.3,"90th_percentile":26242.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":12963.76,"10th_percentile":12963.76,"90th_percentile":12963.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15635.88,"10th_percentile":15635.88,"90th_percentile":15635.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24472.3,"10th_percentile":24472.3,"90th_percentile":24472.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30374.1,"maximum":108512.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":58429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56760.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":108512.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":108512.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":95157.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30374.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33388.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48235.97,"10th_percentile":48235.97,"90th_percentile":48235.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":34989.18,"10th_percentile":34989.18,"90th_percentile":34989.18},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50069.07,"10th_percentile":50069.07,"90th_percentile":50069.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10540.34,"maximum":37826.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20368.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19786.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":37826.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37826.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33171.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10540.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16061.88,"maximum":57701.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":31070.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30182.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":57701.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":57701.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":50600.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16061.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33595.6,"maximum":117741.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":63399.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61587.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":117741.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":117741.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":103249.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33595.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":50867.08,"10th_percentile":50867.08,"90th_percentile":50867.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":22342.46,"10th_percentile":22342.46,"90th_percentile":22342.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41869.45,"10th_percentile":41869.45,"90th_percentile":41869.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18932.13,"maximum":75790.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40810.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39644.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":75790.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":75790.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":66462.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18932.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35153.01,"10th_percentile":35153.01,"90th_percentile":35153.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21134.93,"maximum":74387.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40055.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38910.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":74387.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":74387.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":65232.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21134.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22888.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11967.2,"maximum":41620.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22410.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21770.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":41620.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41620.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36497.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11967.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"1 through 10","median_amount":62676.83,"10th_percentile":62676.83,"90th_percentile":62676.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20081.04,"10th_percentile":20074.04,"90th_percentile":20091.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":47953.0,"10th_percentile":47953.0,"90th_percentile":47953.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20081.94,"10th_percentile":20081.94,"90th_percentile":20081.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":34142.71,"10th_percentile":34142.71,"90th_percentile":34142.71},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9655.1,"10th_percentile":9655.1,"90th_percentile":9655.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9655.1,"10th_percentile":9655.1,"90th_percentile":9655.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":20081.04,"10th_percentile":20081.04,"90th_percentile":20081.04},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19805.63,"10th_percentile":19805.63,"90th_percentile":19805.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11120.92,"10th_percentile":9574.29,"90th_percentile":11967.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":13065.71,"10th_percentile":13065.71,"90th_percentile":13065.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19100.34,"10th_percentile":19100.34,"90th_percentile":19100.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18830.92,"maximum":64231.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":34586.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33598.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":64231.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":64231.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":56326.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18830.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19763.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29899.56,"10th_percentile":29899.56,"90th_percentile":29899.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3293.6,"10th_percentile":3293.6,"90th_percentile":3293.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":13061.72,"10th_percentile":13061.72,"90th_percentile":13061.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15311.08,"maximum":56783.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":30575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29702.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":56783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":56783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49794.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15311.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40920.39,"maximum":157852.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":84997.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82569.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":157852.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":157852.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":138424.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40920.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48570.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4515.4,"maximum":16102.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8670.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8423.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16102.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16102.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14120.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4515.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6365.61,"maximum":22741.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12245.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11895.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22741.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22741.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6365.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10520.46,"10th_percentile":10520.46,"90th_percentile":10520.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14244.74,"maximum":49226.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26506.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25749.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":49226.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49226.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43168.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14244.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4718.48,"maximum":16997.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9152.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8891.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16997.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16997.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14905.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4718.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6234.56,"10th_percentile":6234.56,"90th_percentile":6234.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5763.65,"maximum":20576.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10763.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20576.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20576.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18043.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5763.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":10137.3,"10th_percentile":10137.3,"90th_percentile":10137.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8025.05,"10th_percentile":8025.05,"90th_percentile":8025.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4723.98,"10th_percentile":4723.98,"90th_percentile":4723.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5763.65,"10th_percentile":5763.65,"90th_percentile":5763.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4620.58,"maximum":16570.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8922.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8667.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16570.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16570.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14530.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4620.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3701.09,"maximum":13364.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":7196.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6990.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":13364.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13364.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":11719.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3701.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4112.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6210.95,"10th_percentile":6210.95,"90th_percentile":6214.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":13875.83,"10th_percentile":13875.83,"90th_percentile":13875.83},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3525.98,"10th_percentile":3525.98,"90th_percentile":3525.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6207.94,"10th_percentile":6207.94,"90th_percentile":6207.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4890.47,"maximum":17368.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9352.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9084.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":17368.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17368.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15230.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4890.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7690.92,"10th_percentile":7690.92,"90th_percentile":7690.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8648.73,"10th_percentile":8648.73,"90th_percentile":8648.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9078.04,"10th_percentile":9078.04,"90th_percentile":9078.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6732.93,"10th_percentile":6448.73,"90th_percentile":7756.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7977.69,"maximum":28423.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15305.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14867.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":28423.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28423.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24925.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7977.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13391.02,"10th_percentile":13391.02,"90th_percentile":13395.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12721.99,"10th_percentile":12721.99,"90th_percentile":13380.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6127.47,"maximum":21558.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11608.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11276.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21558.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21558.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18905.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6127.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4965.88,"maximum":17826.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9598.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9324.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":17826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15632.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4965.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7349.22,"10th_percentile":7349.22,"90th_percentile":7349.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":10313.55,"10th_percentile":10313.55,"90th_percentile":10313.55},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7771.3,"maximum":28093.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15127.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14694.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":28093.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28093.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24635.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7771.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4447.93,"maximum":15892.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8557.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8313.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":15892.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15892.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13936.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4447.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7081.36,"maximum":25201.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13569.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13182.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22099.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7081.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10837.35,"maximum":36872.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19854.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19287.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36872.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36872.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32334.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10837.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5224.53,"maximum":5224.53,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5224.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8122.56,"maximum":8122.56,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8122.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3631.64,"maximum":13361.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":7194.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6989.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":13361.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13361.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":11717.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3631.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4111.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7777.6,"10th_percentile":7777.6,"90th_percentile":7777.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8631.91,"maximum":30307.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16319.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15853.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":30307.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30307.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26577.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8631.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14231.43,"10th_percentile":13558.45,"90th_percentile":14489.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3986.21,"10th_percentile":3986.21,"90th_percentile":3986.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":7504.44,"10th_percentile":7504.44,"90th_percentile":7504.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13774.24,"10th_percentile":13748.55,"90th_percentile":14477.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14483.15,"10th_percentile":14483.15,"90th_percentile":14483.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13420.02,"10th_percentile":13420.02,"90th_percentile":13420.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13241.27,"10th_percentile":12723.24,"90th_percentile":14477.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6476.09,"maximum":21948.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11818.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11480.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21948.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21948.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19246.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6476.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18067.55,"maximum":63887.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":34400.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33417.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":63887.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":63887.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":56024.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18067.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19657.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14640.98,"maximum":52239.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":28128.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27325.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":52239.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":52239.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45809.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14640.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4901.05,"maximum":16341.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8799.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8547.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16341.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16341.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14330.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4901.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12934.97,"maximum":46762.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":25179.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24460.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":46762.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":46762.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41006.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12934.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":33077.32,"10th_percentile":33077.32,"90th_percentile":33077.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":30287.43,"10th_percentile":30287.43,"90th_percentile":30287.43},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4796.54,"10th_percentile":4796.54,"90th_percentile":11967.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6097.71,"maximum":21697.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11683.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11349.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21697.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21697.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19027.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6097.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10858.52,"maximum":37869.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20391.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19808.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":37869.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37869.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33208.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10858.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21709.81,"10th_percentile":21709.81,"90th_percentile":21709.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16663.8,"10th_percentile":16663.8,"90th_percentile":16663.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5127.56,"10th_percentile":5127.56,"90th_percentile":11784.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":68973.41,"10th_percentile":68973.41,"90th_percentile":68973.41},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":29232.29,"10th_percentile":29232.29,"90th_percentile":29232.29},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":13998.33,"10th_percentile":13998.33,"90th_percentile":13998.33},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17690.49,"10th_percentile":17690.49,"90th_percentile":17690.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18234.21,"10th_percentile":18234.21,"90th_percentile":18234.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21195.78,"maximum":85138.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":45843.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44534.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":85138.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":85138.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":74660.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21195.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26196.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11938.09,"maximum":42670.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22976.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22320.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":42670.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42670.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37419.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11938.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9987.33,"maximum":32682.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17598.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17095.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":32682.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32682.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28660.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9987.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33316.45,"maximum":116190.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":62563.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60776.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":116190.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":116190.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":101889.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33316.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35750.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20546.85,"maximum":74352.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40035.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38892.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":74352.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":74352.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":65201.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20546.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32961.88,"maximum":116796.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":62890.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61093.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":116796.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":116796.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":102421.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32961.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35937.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30378.06,"maximum":118987.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":64070.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62239.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":118987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":118987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":104342.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30378.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36611.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39353.3,"maximum":155227.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":83584.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81196.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":155227.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":155227.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":136122.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39353.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47762.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72057.86,"maximum":256712.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":138229.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":134280.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":256712.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":256712.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":225117.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72057.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78988.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17755.32,"maximum":64890.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":34941.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33942.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":64890.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":64890.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":56903.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17755.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":7874.04,"10th_percentile":7874.04,"90th_percentile":7874.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5991.87,"maximum":22217.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11963.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11621.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22217.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22217.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19482.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5991.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10073.05,"10th_percentile":10073.05,"90th_percentile":10073.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13360.37,"10th_percentile":13360.37,"90th_percentile":13360.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6078.52,"maximum":22528.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12130.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11784.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22528.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22528.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19756.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6078.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5364.1,"maximum":19065.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10266.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9972.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19065.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19065.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5364.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23418.49,"10th_percentile":23418.49,"90th_percentile":23418.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6940.8,"10th_percentile":6940.8,"90th_percentile":6940.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8797.29,"maximum":30265.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16296.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15830.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":30265.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30265.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26540.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8797.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30652.48,"10th_percentile":30652.48,"90th_percentile":30652.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13945.74,"maximum":49994.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26919.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26150.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":49994.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49994.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43840.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13945.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15382.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23409.59,"10th_percentile":23409.59,"90th_percentile":23409.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":12435.9,"10th_percentile":12435.9,"90th_percentile":12435.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13945.08,"10th_percentile":13945.08,"90th_percentile":13945.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22434.99,"10th_percentile":22434.99,"90th_percentile":22434.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19280.08,"maximum":67758.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":36485.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35443.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":67758.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":67758.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":59419.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19280.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20848.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23706.84,"maximum":88229.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":47507.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46150.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":88229.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":88229.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":77370.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23706.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27147.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13306.73,"maximum":49059.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26416.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25661.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":49059.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49059.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43021.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13306.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20454.9,"maximum":75235.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40511.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39353.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":75235.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":75235.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":65975.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20454.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23149.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6744.65,"maximum":24134.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12624.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21163.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6744.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9958.88,"maximum":37165.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20012.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19440.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":37165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32591.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9958.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5867.55,"10th_percentile":5867.55,"90th_percentile":5867.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15713.46,"10th_percentile":15713.46,"90th_percentile":15713.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10634.94,"maximum":39080.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20441.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39080.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39080.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10634.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12974.66,"maximum":49089.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26433.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25677.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":49089.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49089.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43048.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12974.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11619.25,"maximum":11619.25,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11619.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12820.53,"maximum":42644.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22962.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22306.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":42644.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42644.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37396.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12820.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11613.29,"maximum":44127.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":23760.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23082.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":44127.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":44127.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":38696.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11613.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9241.82,"maximum":31773.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17108.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16620.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31773.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31773.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27863.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9241.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15180.58,"10th_percentile":15180.58,"90th_percentile":15180.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11807.11,"maximum":41268.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22221.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21586.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":41268.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41268.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36189.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11807.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20959.63,"maximum":74713.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40230.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39080.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":74713.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":74713.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":65518.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20959.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22988.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12472.58,"maximum":47368.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":25506.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24777.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":47368.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47368.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12472.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":54147.86,"10th_percentile":54147.86,"90th_percentile":54147.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12471.92,"10th_percentile":12471.92,"90th_percentile":12471.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15882.62,"maximum":59871.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":32238.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31317.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":59871.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":59871.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":52502.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15882.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29627.63,"10th_percentile":29627.63,"90th_percentile":29627.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9714.18,"10th_percentile":9714.18,"90th_percentile":9714.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8112.33,"maximum":26365.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14196.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13790.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":26365.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26365.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23120.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8193.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":24490.89,"10th_percentile":24490.89,"90th_percentile":24490.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12849.13,"maximum":41759.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22485.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21843.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":41759.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41759.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36620.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13000.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12849.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14028.43,"maximum":49366.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26581.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25822.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":49366.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49366.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43290.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14028.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21324.11,"maximum":76184.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":41022.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39850.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":76184.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":76184.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":66807.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21324.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23441.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16855.68,"maximum":65438.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":35235.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34229.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":65438.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":65438.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":57384.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16855.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20134.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10494.04,"maximum":38504.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20733.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20140.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":38504.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":38504.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33765.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10494.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16719.54,"10th_percentile":16719.54,"90th_percentile":16719.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13725.46,"maximum":49446.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26624.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25864.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":49446.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49446.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43360.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13725.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21307.11,"10th_percentile":21307.11,"90th_percentile":21307.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29664.31,"maximum":101345.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":54570.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53011.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":101345.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":101345.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":88872.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29664.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31183.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":16975.2,"10th_percentile":16975.2,"90th_percentile":16975.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30391.77,"10th_percentile":30391.77,"90th_percentile":30391.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32129.06,"maximum":113994.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":61381.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59627.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":113994.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":113994.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":99964.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32129.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12472.58,"maximum":45536.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24519.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23819.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":45536.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45536.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39932.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12472.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":11711.46,"10th_percentile":11711.46,"90th_percentile":11711.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21621.13,"maximum":71606.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":38557.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37455.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":71606.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":71606.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":62793.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21621.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22032.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22655.71,"maximum":83254.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":44829.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43548.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":83254.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":83254.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":73008.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22655.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":14524.03,"10th_percentile":14524.03,"90th_percentile":14524.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28561.59,"maximum":98505.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":53041.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":98505.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":98505.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":86381.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28561.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30309.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20412.57,"maximum":76262.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":41064.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39891.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":76262.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":76262.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":66876.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20412.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23465.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":21568.93,"10th_percentile":21568.93,"90th_percentile":21568.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34065.27,"maximum":125819.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":67749.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65813.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":125819.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":125819.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":110334.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34065.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38713.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":60888.86,"10th_percentile":60888.86,"90th_percentile":60888.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27010.37,"maximum":100115.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":53908.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52368.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":100115.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":100115.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":87793.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27010.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30804.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"1 through 10","median_amount":134893.84,"10th_percentile":134893.84,"90th_percentile":134893.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5273.48,"maximum":19530.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10516.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10216.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19530.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19530.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17126.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5273.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7173.31,"maximum":25836.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13911.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13514.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25836.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25836.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22656.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7173.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11809.28,"10th_percentile":11809.28,"90th_percentile":11809.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11142.97,"maximum":39446.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21240.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20633.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39446.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39446.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34591.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11142.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4647.7,"maximum":16518.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8894.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8640.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16518.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16518.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14485.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4647.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9559.19,"10th_percentile":9559.19,"90th_percentile":9559.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12504.33,"maximum":42368.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22813.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22162.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":42368.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42368.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37154.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12504.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4068.89,"maximum":14669.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":7899.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7673.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":14669.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14669.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":12864.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4068.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"1 through 10","median_amount":13031.8,"10th_percentile":13031.8,"90th_percentile":13031.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":7455.19,"10th_percentile":7455.19,"90th_percentile":7455.19},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3844.72,"10th_percentile":3844.72,"90th_percentile":3844.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14218.83,"10th_percentile":14218.83,"90th_percentile":14218.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3255.11,"10th_percentile":3255.11,"90th_percentile":3255.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5690.22,"maximum":19858.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10387.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19858.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19858.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17414.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5690.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":19742.99,"10th_percentile":19742.99,"90th_percentile":19742.99},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14885.32,"10th_percentile":14885.32,"90th_percentile":14885.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1484.26,"10th_percentile":1484.26,"90th_percentile":1484.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11006.04,"maximum":38485.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20722.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20130.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":38485.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":38485.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33748.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11006.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5193.44,"maximum":20144.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10847.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10537.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20144.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20144.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17665.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5193.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4606.69,"maximum":16820.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8798.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16820.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16820.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14750.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4606.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12959.45,"maximum":46464.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":25019.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24304.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":46464.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":46464.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":40745.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12959.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":7406.83,"10th_percentile":7406.83,"90th_percentile":7406.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36184.71,"maximum":136147.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":73310.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71215.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":136147.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":136147.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":119391.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36184.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41891.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55169.1,"maximum":212695.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":114528.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":111256.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":212695.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":212695.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":186518.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55169.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65444.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9719.42,"maximum":33038.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17790.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17281.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33038.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33038.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28972.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9719.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10970.98,"maximum":39934.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21503.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20888.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39934.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39934.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35019.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10970.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15720.55,"maximum":56337.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":30335.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29468.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":56337.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":56337.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49403.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15720.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13084.47,"maximum":48790.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26271.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25520.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":48790.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":48790.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42785.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13084.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2667.01,"10th_percentile":2667.01,"90th_percentile":2667.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23176.31,"maximum":84104.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":45287.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43993.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":84104.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":84104.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":73753.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23176.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10996.78,"maximum":39200.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21108.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20504.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39200.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39200.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34375.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10996.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18101.29,"maximum":77983.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":41991.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40791.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":77983.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":77983.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":68385.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18101.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10259.87,"maximum":37481.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20182.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19605.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":37481.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37481.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32868.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10259.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23159.78,"maximum":84175.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":45325.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44030.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":84175.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":84175.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":73815.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23159.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25900.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7435.92,"maximum":27023.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14551.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14135.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":27023.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27023.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23697.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7435.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12481.17,"10th_percentile":12481.17,"90th_percentile":12481.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":31044.79,"10th_percentile":31044.79,"90th_percentile":31044.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5947.15,"10th_percentile":5947.15,"90th_percentile":5947.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10010.48,"maximum":35732.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19240.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18690.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":35732.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35732.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31334.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10010.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":30870.42,"10th_percentile":30870.42,"90th_percentile":30870.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16389.32,"maximum":56538.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":30443.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29573.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":56538.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":56538.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49579.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16389.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6226.7,"maximum":22089.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11894.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11554.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22089.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22089.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19370.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6226.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":37058.67,"10th_percentile":37058.67,"90th_percentile":37058.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8886.02,"10th_percentile":8886.02,"90th_percentile":8886.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10953.78,"maximum":37755.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20330.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19749.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":37755.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37755.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33108.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10953.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11617.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5161.68,"maximum":18404.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9910.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9627.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18404.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18404.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16139.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5161.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5662.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"1 through 10","median_amount":8463.54,"10th_percentile":8463.54,"90th_percentile":8463.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5074.59,"10th_percentile":5074.59,"90th_percentile":5074.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8305.73,"10th_percentile":8305.73,"90th_percentile":8305.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":15259.58,"10th_percentile":15259.58,"90th_percentile":15259.58},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5161.68,"10th_percentile":5161.68,"90th_percentile":5161.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8499.61,"maximum":29941.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16122.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15661.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":29941.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29941.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26256.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8499.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3619.07,"maximum":12842.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":6915.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6717.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":12842.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":12842.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":11261.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3619.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6044.96,"10th_percentile":6044.96,"90th_percentile":6044.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":12830.13,"10th_percentile":12830.13,"90th_percentile":12830.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5303.25,"maximum":18645.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10039.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9752.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18645.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18645.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16350.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5303.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5737.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8551.18,"10th_percentile":8551.18,"90th_percentile":8551.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7083.83,"10th_percentile":7083.83,"90th_percentile":7083.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5265.83,"10th_percentile":5265.83,"90th_percentile":5265.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3424.0,"10th_percentile":3424.0,"90th_percentile":3424.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8930.67,"10th_percentile":8930.67,"90th_percentile":8930.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5302.58,"10th_percentile":5302.58,"90th_percentile":5302.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9177.61,"10th_percentile":9177.61,"90th_percentile":9177.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9724.05,"maximum":34863.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18772.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18236.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":34863.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34863.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30572.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9724.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10727.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4434.03,"maximum":16083.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8660.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8413.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16083.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16083.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4434.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4948.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4956.62,"maximum":18900.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10177.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9886.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18900.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18900.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16574.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4956.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12729.24,"maximum":46323.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24943.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24230.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":46323.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":46323.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":40621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12729.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4211.11,"maximum":14882.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8013.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7784.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":14882.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14882.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4211.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4579.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6521.73,"maximum":23152.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12466.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12110.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23152.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23152.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20302.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6521.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9440.29,"10th_percentile":9440.29,"90th_percentile":9440.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":14664.22,"10th_percentile":14664.22,"90th_percentile":14664.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10944.97,"10th_percentile":10944.97,"90th_percentile":10944.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12026.73,"maximum":43154.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":23237.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22573.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":43154.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43154.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37843.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12026.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13278.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19989.59,"10th_percentile":19989.59,"90th_percentile":19989.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":25936.93,"10th_percentile":25936.93,"90th_percentile":25936.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5840.38,"maximum":21820.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11749.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11413.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21820.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21820.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19134.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5840.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8127.85,"maximum":28555.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15376.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14936.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":28555.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28555.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8127.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3965.69,"maximum":14282.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":7690.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7470.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":14282.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14282.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":12524.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3965.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4394.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9720.08,"maximum":33553.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18067.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17551.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33553.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33553.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29423.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9720.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16028.57,"10th_percentile":16028.57,"90th_percentile":16028.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8539.98,"10th_percentile":8539.98,"90th_percentile":8539.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5827.15,"maximum":20559.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11070.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10754.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20559.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20559.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18029.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5827.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9772.92,"10th_percentile":9772.92,"90th_percentile":9772.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":7382.48,"10th_percentile":7382.48,"90th_percentile":7382.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7452.61,"10th_percentile":7452.61,"90th_percentile":7452.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":11319.29,"10th_percentile":11319.29,"90th_percentile":11319.29},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9446.0,"10th_percentile":9446.0,"90th_percentile":9446.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6788.01,"10th_percentile":6788.01,"90th_percentile":6788.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9827.91,"maximum":34752.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18713.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18178.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":34752.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34752.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30475.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9827.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6110.28,"maximum":21624.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11644.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11311.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21624.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21624.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18963.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6110.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9543.23,"10th_percentile":9543.23,"90th_percentile":9543.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5717.34,"maximum":21398.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11522.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11192.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21398.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21398.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18764.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5717.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25332.16,"maximum":82329.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":44331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43064.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":82329.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":82329.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":72196.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25566.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21455.82,"10th_percentile":21455.82,"90th_percentile":21455.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":14057.75,"10th_percentile":14057.75,"90th_percentile":14057.75},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19677.92,"10th_percentile":19677.92,"90th_percentile":19677.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8235.68,"maximum":33482.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18029.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17514.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33482.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33482.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29361.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8235.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10563.49,"maximum":37779.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20342.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19761.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":37779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33129.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10563.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9669.15,"maximum":35609.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19174.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18626.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":35609.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35609.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31227.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9669.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12661.11,"maximum":42349.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22803.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22152.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":42349.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42349.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37137.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12661.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18964.54,"maximum":71297.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":38391.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37294.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":71297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":71297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":62522.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18964.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21937.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9268.94,"maximum":34455.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18552.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18022.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":34455.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34455.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30214.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9268.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9633.42,"maximum":33917.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18263.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17741.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33917.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33917.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29742.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9633.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4328.37,"10th_percentile":4328.37,"90th_percentile":4328.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6067.28,"maximum":21157.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11392.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11066.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21157.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21157.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18553.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6067.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":9885.33,"10th_percentile":9885.33,"90th_percentile":10825.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":8464.77,"10th_percentile":8464.77,"90th_percentile":8464.77},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5247.18,"10th_percentile":5247.18,"90th_percentile":5247.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4073.39,"10th_percentile":4073.39,"90th_percentile":4324.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6067.28,"10th_percentile":4853.82,"90th_percentile":6067.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4324.38,"10th_percentile":4324.38,"90th_percentile":4324.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9309.52,"10th_percentile":9309.52,"90th_percentile":9309.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4144.96,"maximum":14665.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":7896.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7670.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":14665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":12860.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4144.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4512.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4073.39,"10th_percentile":4073.39,"90th_percentile":4073.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4069.4,"10th_percentile":4069.4,"90th_percentile":4069.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4144.96,"10th_percentile":4144.96,"90th_percentile":4144.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8785.38,"maximum":31530.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16977.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16492.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31530.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31530.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27649.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8785.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8784.72,"10th_percentile":8784.72,"90th_percentile":8784.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5169.62,"maximum":18371.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9892.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9609.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18371.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18371.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16110.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5169.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8693.75,"10th_percentile":8693.75,"90th_percentile":8693.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5255.62,"10th_percentile":5255.62,"90th_percentile":5255.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8670.06,"10th_percentile":8670.06,"90th_percentile":8670.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8209.88,"maximum":33572.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18077.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17561.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33572.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33572.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29440.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8209.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16502.13,"10th_percentile":16502.13,"90th_percentile":16502.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6836.6,"maximum":24197.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13029.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12657.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24197.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24197.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21219.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6836.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5153.09,"maximum":18137.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9766.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9487.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15905.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5153.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5580.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8863.44,"maximum":31202.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16321.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31202.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31202.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27362.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8863.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19738.6,"10th_percentile":19738.6,"90th_percentile":19738.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10103.09,"maximum":35888.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19324.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18772.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":35888.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35888.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31471.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10103.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6744.65,"maximum":23003.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12386.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12032.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23003.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23003.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20172.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6744.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10234.91,"10th_percentile":10234.91,"90th_percentile":10234.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4948.02,"maximum":17689.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9524.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9252.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":17689.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17689.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15512.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4948.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19913.8,"maximum":69432.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":37386.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36318.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":69432.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":69432.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":60887.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19913.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21363.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7556.98,"maximum":27061.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14571.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14155.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":27061.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27061.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23730.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7556.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17613.1,"maximum":62576.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":33695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32732.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":62576.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":62576.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":54875.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17613.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21558.95,"maximum":76453.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":41167.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39991.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":76453.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":76453.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":67043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21558.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19173.03,"10th_percentile":19173.03,"90th_percentile":19173.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9519.65,"maximum":34068.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18344.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17820.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":34068.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34068.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29875.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9519.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13542.89,"maximum":50537.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":27212.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26434.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":50537.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":50537.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":44317.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13542.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15549.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13601.76,"maximum":45687.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24601.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23898.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":45687.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45687.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":40064.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13601.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5613.49,"maximum":20463.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11018.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10703.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20463.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20463.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17944.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5613.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11619.25,"maximum":39356.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20586.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39356.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39356.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34512.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11619.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12109.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7455.85,"10th_percentile":7455.85,"90th_percentile":7455.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5588.85,"maximum":18163.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9780.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9501.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18163.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18163.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15928.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5655.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5719.6,"maximum":18588.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10009.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9723.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18588.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18588.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16300.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5786.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7017.19,"maximum":24268.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13067.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12694.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24268.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24268.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21281.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7017.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4998.96,"maximum":17814.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9592.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":17814.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17814.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15621.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4998.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16714.12,"maximum":58587.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":31546.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30645.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":58587.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":58587.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":51376.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16714.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13325.92,"maximum":45584.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24545.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23844.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":45584.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45584.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39973.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13325.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11287.17,"maximum":39568.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20697.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39568.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39568.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34698.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11287.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12175.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6375.54,"maximum":22694.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12219.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11870.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22694.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22694.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19900.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6375.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9607.47,"10th_percentile":9607.47,"90th_percentile":9607.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8907.1,"maximum":31204.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16802.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16322.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31204.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31204.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8907.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3354.92,"10th_percentile":3354.92,"90th_percentile":3354.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10251.27,"maximum":35102.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18901.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18361.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":35102.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35102.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10251.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5714.04,"maximum":21086.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11029.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21086.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21086.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18491.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5714.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8521.56,"10th_percentile":8521.56,"90th_percentile":8521.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12278.1,"maximum":44026.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":23706.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23028.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":44026.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":44026.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":38607.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12278.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7533.16,"maximum":26584.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14314.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13905.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":26584.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26584.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23312.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7533.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5600.9,"10th_percentile":5600.9,"90th_percentile":5600.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5408.42,"maximum":18978.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10219.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9927.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18978.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18978.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16642.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5408.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9682.38,"maximum":33636.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18111.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17594.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33636.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33636.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29496.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9682.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10380.26,"maximum":36440.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19061.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36440.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36440.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31955.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10380.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6244.78,"maximum":20295.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10928.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10616.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20295.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20295.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17797.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6317.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17122.27,"maximum":60615.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":32638.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31706.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":60615.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":60615.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":53154.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17122.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18650.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7343.31,"maximum":25680.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13827.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13432.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25680.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25680.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22519.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7343.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4232.94,"maximum":15666.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8435.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8194.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":15666.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15666.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13737.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4232.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4820.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7252.02,"maximum":25298.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13622.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13232.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25298.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25298.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22184.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7252.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4878.78,"10th_percentile":4878.78,"90th_percentile":4878.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4362.05,"10th_percentile":4362.05,"90th_percentile":4362.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9191.54,"maximum":39892.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21480.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20866.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39892.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39892.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9191.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7117.08,"maximum":23671.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12746.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12381.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23671.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23671.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20758.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7117.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":22844.54,"10th_percentile":22844.54,"90th_percentile":22844.54},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4719.14,"maximum":15455.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8322.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8084.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":15455.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15455.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13553.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4719.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2593.97,"10th_percentile":2593.97,"90th_percentile":2593.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3775.84,"10th_percentile":3775.84,"90th_percentile":3775.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6111.13,"maximum":19861.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10694.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10388.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19861.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19861.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17416.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6183.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12184.83,"maximum":57959.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":31208.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30317.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":57959.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":57959.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":50825.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12184.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12078.32,"10th_percentile":12078.32,"90th_percentile":12078.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7164.05,"maximum":25026.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13475.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13090.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25026.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25026.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21946.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7164.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5248.83,"10th_percentile":5248.83,"90th_percentile":5248.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5827.9,"10th_percentile":5827.9,"90th_percentile":5827.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34832.23,"10th_percentile":34832.23,"90th_percentile":34832.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6311.3,"10th_percentile":6311.3,"90th_percentile":6311.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5787.46,"maximum":22611.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12175.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11827.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22611.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22611.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19828.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5787.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5244.84,"10th_percentile":5244.84,"90th_percentile":5244.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":30910.62,"10th_percentile":30910.62,"90th_percentile":30910.62},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":18145.17,"10th_percentile":18145.17,"90th_percentile":18145.17},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5778.2,"10th_percentile":5778.2,"90th_percentile":5778.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10688.52,"maximum":38940.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20968.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20369.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":38940.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":38940.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34148.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10688.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":7112.19,"10th_percentile":7112.19,"90th_percentile":7112.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":22860.48,"10th_percentile":22860.48,"90th_percentile":22860.48},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5955.4,"10th_percentile":5955.4,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5959.39,"10th_percentile":5959.39,"90th_percentile":5959.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4935.43,"10th_percentile":4935.43,"90th_percentile":4935.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":21653.31,"10th_percentile":21653.31,"90th_percentile":21653.31},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":4935.43,"10th_percentile":4935.43,"90th_percentile":4935.43},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":18164.28,"10th_percentile":18164.28,"90th_percentile":18164.28},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21918.24,"10th_percentile":21918.24,"90th_percentile":21918.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6883.33,"10th_percentile":6384.62,"90th_percentile":7387.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5827.9,"10th_percentile":5827.9,"90th_percentile":5827.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5986.58,"maximum":22635.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12188.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11839.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22635.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22635.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19849.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5986.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":14266.3,"10th_percentile":14266.3,"90th_percentile":14266.3},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4939.42,"10th_percentile":4935.43,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":19167.23,"10th_percentile":19167.23,"90th_percentile":25811.18},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":17635.26,"10th_percentile":17635.26,"90th_percentile":17635.26},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4935.43,"10th_percentile":4935.43,"90th_percentile":4935.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26790.77,"10th_percentile":26790.77,"90th_percentile":26790.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5483.7,"10th_percentile":1926.23,"90th_percentile":6433.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4935.43,"10th_percentile":4935.43,"90th_percentile":4935.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11924.86,"maximum":42545.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22909.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22254.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":42545.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42545.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37309.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11924.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13091.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39326.18,"maximum":140312.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":75552.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73394.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":140312.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":140312.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":123043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39326.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43173.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":2148.56,"10th_percentile":2148.56,"90th_percentile":2148.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3506.55,"10th_percentile":3506.55,"90th_percentile":3506.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5835.68,"10th_percentile":5835.68,"90th_percentile":5835.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4451.15,"10th_percentile":4451.15,"90th_percentile":4451.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26857.56,"maximum":95823.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":51597.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50123.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":95823.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":95823.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":84030.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26857.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29484.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":2410.99,"10th_percentile":2410.99,"90th_percentile":2410.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2287.57,"10th_percentile":2287.57,"90th_percentile":2287.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16205.43,"maximum":57820.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":31133.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30244.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":57820.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":57820.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":50703.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16205.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":5512.27,"10th_percentile":5512.27,"90th_percentile":5512.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3506.55,"10th_percentile":3506.55,"90th_percentile":3506.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1966.5,"10th_percentile":1966.5,"90th_percentile":1966.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3704.95,"10th_percentile":3704.95,"90th_percentile":3704.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27588.52,"maximum":98434.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":53003.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51488.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":98434.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":98434.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":86319.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27588.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":2314.31,"10th_percentile":2314.31,"90th_percentile":2314.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3506.55,"10th_percentile":3506.55,"90th_percentile":3506.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1295.65,"10th_percentile":1295.65,"90th_percentile":1295.65},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9293.0,"10th_percentile":9293.0,"90th_percentile":9293.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":3522.02,"10th_percentile":3522.02,"90th_percentile":3522.02},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3510.54,"10th_percentile":3510.54,"90th_percentile":3510.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9765.06,"maximum":34842.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18761.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18225.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":34842.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34842.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30554.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9765.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"1 through 10","median_amount":1283.54,"10th_percentile":1283.54,"90th_percentile":1283.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1293.9,"10th_percentile":1293.9,"90th_percentile":1293.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1966.5,"10th_percentile":1966.5,"90th_percentile":3506.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"14","median_amount":1662.53,"10th_percentile":1662.53,"90th_percentile":3506.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1970.49,"10th_percentile":1966.5,"90th_percentile":3506.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":5231.75,"10th_percentile":5231.75,"90th_percentile":5231.75},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2229.5,"10th_percentile":2229.5,"90th_percentile":2898.0},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1662.53,"10th_percentile":1662.53,"90th_percentile":1966.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5014.32,"10th_percentile":5014.32,"90th_percentile":5014.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4291.25,"10th_percentile":4291.25,"90th_percentile":4291.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":3137.55,"10th_percentile":683.11,"90th_percentile":8653.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1321.68,"maximum":4716.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2539.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":4716.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":4716.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":4136.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1321.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"1 through 10","median_amount":1745.56,"10th_percentile":1326.78,"90th_percentile":2733.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1920.1,"10th_percentile":1920.1,"90th_percentile":1920.1},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1739.82,"10th_percentile":1739.82,"90th_percentile":4158.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1662.53,"10th_percentile":1662.53,"90th_percentile":1666.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"42","median_amount":1662.53,"10th_percentile":1662.53,"90th_percentile":1666.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4010.64,"10th_percentile":4010.64,"90th_percentile":4010.64},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"12","median_amount":1662.53,"10th_percentile":1662.53,"90th_percentile":1666.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":3083.8,"10th_percentile":2319.65,"90th_percentile":5158.65},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":3030.51,"10th_percentile":3030.51,"90th_percentile":4342.67},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":2409.33,"10th_percentile":2409.33,"90th_percentile":2409.33},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1666.52,"10th_percentile":1662.53,"90th_percentile":2989.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4372.0,"10th_percentile":4372.0,"90th_percentile":4372.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"29","median_amount":1189.51,"10th_percentile":1057.34,"90th_percentile":1508.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8444.71,"maximum":27550.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14834.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":27550.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27550.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24159.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8444.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8476.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31451.02,"maximum":106916.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":57570.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55925.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":106916.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":106916.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":93757.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31451.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32897.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19273.46,"maximum":66323.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":35712.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34692.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":66323.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":66323.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":58160.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19273.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23712.13,"maximum":94055.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":50645.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49198.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":94055.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":94055.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":82479.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23712.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28940.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7312.88,"maximum":32012.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17237.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16744.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":32012.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32012.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28072.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7312.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6601.11,"maximum":25477.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13718.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13326.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25477.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25477.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22341.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6601.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":6736.08,"10th_percentile":6736.08,"90th_percentile":6736.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5188.87,"10th_percentile":5188.87,"90th_percentile":5188.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4331.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5424.38,"10th_percentile":5424.38,"90th_percentile":5424.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4785.95,"maximum":17800.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9310.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":17800.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17800.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15609.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4785.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4331.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"12","median_amount":6481.54,"10th_percentile":4391.94,"90th_percentile":9164.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4331.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4341.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10179.71,"10th_percentile":10179.71,"90th_percentile":10179.71},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":11849.5,"10th_percentile":11849.5,"90th_percentile":11849.5},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":7376.52,"10th_percentile":7376.52,"90th_percentile":7376.52},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4331.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8526.48,"10th_percentile":8526.48,"90th_percentile":8526.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4307.95,"10th_percentile":3350.63,"90th_percentile":4786.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4215.08,"maximum":15916.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8570.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8325.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":15916.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15916.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":13957.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4215.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4897.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"1 through 10","median_amount":5850.94,"10th_percentile":5850.94,"90th_percentile":7475.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4331.39},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8357.7,"10th_percentile":8357.7,"90th_percentile":8357.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4331.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"17","median_amount":4331.39,"10th_percentile":3938.79,"90th_percentile":4335.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":7752.87,"10th_percentile":7752.87,"90th_percentile":7752.87},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4331.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":5316.96,"10th_percentile":5316.96,"90th_percentile":5316.96},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":5943.26,"10th_percentile":5943.26,"90th_percentile":5943.26},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"1 through 10","median_amount":14274.79,"10th_percentile":14274.79,"90th_percentile":14274.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4331.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":3794.17,"10th_percentile":2619.46,"90th_percentile":4240.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3938.79,"10th_percentile":3938.79,"90th_percentile":3938.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15151.0,"maximum":52123.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":28066.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27264.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":52123.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":52123.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45708.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15151.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9305.98,"maximum":33152.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17851.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17341.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33152.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33152.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29072.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9305.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6104.98,"maximum":21676.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11672.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11338.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21676.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21676.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19008.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6104.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9897.06,"10th_percentile":9897.06,"90th_percentile":9897.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8992.88,"10th_percentile":8992.88,"90th_percentile":8992.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6104.98,"10th_percentile":6104.98,"90th_percentile":6104.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10240.06,"10th_percentile":10240.06,"90th_percentile":10240.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10239.36,"maximum":36008.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19389.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18835.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36008.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36008.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31576.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10239.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7252.02,"10th_percentile":7252.02,"90th_percentile":7252.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4935.43,"10th_percentile":4935.43,"90th_percentile":4935.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5248.83,"10th_percentile":5248.83,"90th_percentile":5248.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5248.83,"10th_percentile":5248.83,"90th_percentile":5827.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5244.84,"10th_percentile":5244.84,"90th_percentile":5244.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":22502.09,"10th_percentile":22502.09,"90th_percentile":22502.09},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4443.67,"10th_percentile":4443.67,"90th_percentile":4443.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20398.01,"maximum":74600.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40169.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39021.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":74600.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":74600.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":65418.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20398.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7613.2,"maximum":28388.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15285.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14849.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":28388.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28388.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24894.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7613.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":18483.45,"10th_percentile":18483.45,"90th_percentile":18483.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5955.4,"10th_percentile":5955.4,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":8003.17,"10th_percentile":8003.17,"90th_percentile":8003.17},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4874.79,"10th_percentile":4874.79,"90th_percentile":4874.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7942.12,"10th_percentile":7942.12,"90th_percentile":9254.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5955.4,"10th_percentile":5955.4,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":23186.36,"10th_percentile":23186.36,"90th_percentile":23186.36},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":4403.27,"10th_percentile":4403.27,"90th_percentile":4403.27},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":25142.67,"10th_percentile":25142.67,"90th_percentile":25142.67},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5955.4,"10th_percentile":5955.4,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9048.17,"10th_percentile":9048.17,"90th_percentile":9048.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4335.38,"10th_percentile":4335.38,"90th_percentile":4335.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":3470.79,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4935.43,"10th_percentile":3938.79,"90th_percentile":5099.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":6883.78,"10th_percentile":6883.78,"90th_percentile":6883.78},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":19689.93,"10th_percentile":19689.93,"90th_percentile":19689.93},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3938.79,"10th_percentile":3938.79,"90th_percentile":3938.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25368.22,"10th_percentile":25368.22,"90th_percentile":25368.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4173.3,"10th_percentile":3999.33,"90th_percentile":5231.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4939.42,"10th_percentile":4939.42,"90th_percentile":4939.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36560.44,"maximum":129603.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":69786.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67792.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":129603.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":129603.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":113652.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36560.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14128.32,"maximum":49240.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26514.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25756.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":49240.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":49240.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43180.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14128.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8405.68,"maximum":28789.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15502.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15059.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":28789.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28789.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25246.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8405.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8858.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12522.86,"maximum":47092.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":25357.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24633.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":47092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41296.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12522.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5534.77,"maximum":20104.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10825.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10516.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20104.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20104.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17629.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5534.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60932.75,"maximum":204430.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":110078.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":106933.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":204430.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":204430.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":179270.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60932.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62901.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33084.92,"maximum":116589.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":62778.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60985.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":116589.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":116589.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":102239.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33084.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":8082.4,"10th_percentile":8082.4,"90th_percentile":8082.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33083.6,"10th_percentile":33083.6,"90th_percentile":33083.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9074.37,"10th_percentile":9074.37,"90th_percentile":9074.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13218.09,"maximum":47170.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":25399.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24673.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":47170.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47170.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41364.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13218.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14514.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10752.68,"maximum":35345.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19032.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18488.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":35345.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35345.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30995.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10752.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10875.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29842.25,"maximum":107384.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":57822.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56170.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":107384.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":107384.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":94167.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29842.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33041.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12162.34,"maximum":43053.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":23182.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":43053.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43053.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37754.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12162.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20411.35,"10th_percentile":20411.35,"90th_percentile":20411.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6614.34,"maximum":23558.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12685.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12322.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23558.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23558.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20658.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6614.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":24652.66,"10th_percentile":24652.66,"90th_percentile":24652.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5939.61,"maximum":20956.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11284.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10961.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20956.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20956.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18377.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5939.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9763.08,"maximum":35371.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19046.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18501.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":35371.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35371.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31018.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9763.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10883.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5852.29,"maximum":20529.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10738.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20529.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20529.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5852.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4759.49,"maximum":17226.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9275.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9010.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":17226.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":17226.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":15106.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4759.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46017.25,"maximum":163171.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":87861.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85351.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":163171.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":163171.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":143089.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46017.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50206.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12980.61,"maximum":45857.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24692.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23987.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":45857.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45857.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":40213.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12980.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21785.53,"10th_percentile":21782.53,"90th_percentile":22676.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":19670.53,"10th_percentile":19670.53,"90th_percentile":19670.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":8082.4,"10th_percentile":8082.4,"90th_percentile":8082.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21770.53,"10th_percentile":20222.13,"90th_percentile":54353.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":13143.83,"10th_percentile":13143.83,"90th_percentile":25656.94},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39289.04,"10th_percentile":39289.04,"90th_percentile":39289.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":16137.16,"10th_percentile":16137.16,"90th_percentile":16137.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21793.33,"10th_percentile":21793.33,"90th_percentile":21793.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":16375.59,"10th_percentile":16375.59,"90th_percentile":16375.59},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":16137.16,"10th_percentile":16137.16,"90th_percentile":16137.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12979.29,"10th_percentile":12979.29,"90th_percentile":12979.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2097.07,"10th_percentile":2097.07,"90th_percentile":2097.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21787.04,"10th_percentile":21787.04,"90th_percentile":21787.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6820.07,"maximum":24157.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13008.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12636.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24157.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24157.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21184.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6820.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11439.48,"10th_percentile":11439.48,"90th_percentile":11439.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4790.06,"10th_percentile":4790.06,"90th_percentile":4790.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6820.07,"10th_percentile":6820.07,"90th_percentile":6820.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25992.98,"maximum":91241.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":49129.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47726.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":91241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":91241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":80011.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25992.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6046.77,"maximum":22212.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11960.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11618.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22212.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22212.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19478.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6046.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11047.71,"maximum":37982.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20452.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19867.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":37982.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37982.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33307.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11047.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11883.19,"maximum":48993.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26380.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25627.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":48993.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":48993.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42963.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11883.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6930.5,"10th_percentile":6930.5,"90th_percentile":6930.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":8942.99,"10th_percentile":8942.99,"90th_percentile":8942.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5835.75,"maximum":20840.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11222.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10901.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20840.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20840.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18275.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5835.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":8634.88,"10th_percentile":8634.88,"90th_percentile":8634.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5852.0,"10th_percentile":5852.0,"90th_percentile":5852.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":8942.99,"10th_percentile":8942.99,"90th_percentile":8942.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29305.77,"maximum":99072.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":53346.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51822.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":99072.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":99072.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":86878.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29305.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12551.3,"maximum":45196.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24336.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23641.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":45196.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45196.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39634.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12551.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8063.69,"maximum":27611.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14867.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14442.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":27611.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27611.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24213.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8063.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25539.85,"maximum":86713.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":46691.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45357.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":86713.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":86713.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":76041.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25539.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26350.85,"maximum":90637.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":48804.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47410.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":90637.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":90637.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":79481.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26350.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27888.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8389.14,"maximum":30989.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16686.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16210.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":30989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27175.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8389.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10704.39,"maximum":38589.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20778.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20185.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":38589.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":38589.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33839.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10704.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6061.32,"maximum":20904.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11256.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10934.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20904.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20904.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18331.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6061.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10845.95,"maximum":37026.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19937.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19367.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":37026.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37026.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":32469.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10845.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12061.79,"maximum":43221.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":23272.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22607.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":43221.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43221.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37901.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12061.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4784.71,"10th_percentile":4784.71,"90th_percentile":4784.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6719.52,"maximum":23662.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12741.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12377.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23662.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23662.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20749.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6719.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":42933.86,"10th_percentile":42933.86,"90th_percentile":42933.86},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4548.47,"maximum":16251.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8750.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8500.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16251.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16251.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14251.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4548.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":155088.1,"maximum":504036.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":271404.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263649.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":504036.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":504036.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":442001.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156926.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155088.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21037.02,"maximum":76035.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40942.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39772.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":76035.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":76035.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":66677.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21037.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28287.12,"maximum":91933.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":49502.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":91933.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":91933.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":80618.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28621.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28287.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14193.81,"maximum":52187.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":28100.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27297.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":52187.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":52187.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":45764.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14193.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16057.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12927.03,"maximum":47869.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":25775.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25039.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":47869.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47869.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41977.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12927.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8507.55,"maximum":29967.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16136.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":29967.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29967.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26279.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8507.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5255.62,"maximum":18897.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10175.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9885.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18897.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18897.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16572.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5255.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4673.44,"10th_percentile":4673.44,"90th_percentile":4673.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7136.92,"maximum":28086.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15123.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14691.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":28086.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28086.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24629.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7136.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3877.05,"maximum":14818.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":7979.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7751.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":14818.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14818.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":12994.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3877.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49372.38,"maximum":179888.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":96862.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":94095.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":179888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":179888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":157748.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49372.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55350.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17970.31,"maximum":64538.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":34751.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33758.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":64538.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":64538.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":56595.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17970.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19858.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9923.82,"maximum":36181.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19482.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18925.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36181.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36181.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31728.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9923.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6036.19,"maximum":22203.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11613.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":22203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19470.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6036.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17550.92,"maximum":62262.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":33526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32568.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":62262.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":62262.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":54599.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17550.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19752.39,"maximum":68131.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":36686.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35638.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":68131.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":68131.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":59746.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19752.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20963.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9401.9,"maximum":30571.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16461.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15991.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":30571.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30571.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":26809.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9401.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6557.13,"maximum":21310.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11474.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11147.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":21310.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21310.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18687.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6634.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31449.69,"maximum":110762.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":59641.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57937.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":110762.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":110762.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":97130.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31449.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16196.83,"maximum":58039.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":31252.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30359.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":58039.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":58039.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":50896.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16196.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11034.48,"maximum":40463.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21788.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21165.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":40463.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":40463.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35483.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11034.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7642.97,"maximum":28310.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15244.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14808.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":28310.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":28310.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24826.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7642.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50648.41,"maximum":50648.41,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50648.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34521.7,"maximum":34521.7,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34521.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46895.06,"maximum":46895.06,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46895.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33456.69,"maximum":33456.69,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33456.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42341.95,"maximum":42341.95,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42341.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33211.93,"maximum":33211.93,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33211.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19814.57,"maximum":19814.57,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19814.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12631.34,"maximum":12631.34,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12631.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19909.83,"maximum":19909.83,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19909.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12017.47,"maximum":12017.47,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12017.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17572.75,"maximum":17572.75,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17572.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10771.87,"maximum":10771.87,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10771.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7937.34,"maximum":7937.34,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7937.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14943.29,"maximum":14943.29,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14943.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9612.92,"maximum":9612.92,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9612.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6321.29,"maximum":23071.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12423.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12068.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23071.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23071.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20232.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6321.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7238.79,"maximum":25484.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13722.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13330.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25484.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25484.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22347.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7238.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7841.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15269.4,"maximum":55208.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":29727.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28878.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":55208.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":55208.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":48414.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15269.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10353.8,"maximum":38749.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":20865.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20269.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":38749.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":38749.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33980.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10353.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9935.73,"maximum":34963.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18826.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18288.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":34963.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34963.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30659.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9935.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16157.53,"10th_percentile":16157.53,"90th_percentile":16157.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5880.07,"maximum":20675.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11133.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10814.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":20675.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":20675.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18130.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5880.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8761.95,"10th_percentile":8761.95,"90th_percentile":8761.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4018.61,"maximum":14171.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":7630.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7412.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":14171.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14171.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":12427.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4018.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4360.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12473.24,"maximum":42581.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":22928.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22273.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":42581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37340.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12473.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4790.58,"maximum":18657.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10046.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9759.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18657.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18657.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16360.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4790.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7742.2,"maximum":27392.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14749.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14328.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":27392.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27392.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24020.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7742.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13309.48,"10th_percentile":13309.48,"90th_percentile":13309.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12073.7,"10th_percentile":11342.62,"90th_percentile":12245.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6902.28,"10th_percentile":6902.28,"90th_percentile":6902.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12921.25,"10th_percentile":12921.25,"90th_percentile":12921.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5309.2,"maximum":19110.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10290.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9996.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":19110.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":19110.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16758.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5309.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8905.27,"10th_percentile":8614.19,"90th_percentile":8912.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8577.67,"10th_percentile":8131.07,"90th_percentile":8917.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3808.96,"10th_percentile":3808.96,"90th_percentile":3808.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4794.05,"10th_percentile":4794.05,"90th_percentile":4794.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3399.16,"10th_percentile":3399.16,"90th_percentile":3399.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7556.37,"10th_percentile":7556.37,"90th_percentile":7556.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9726.03,"maximum":31740.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17091.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16602.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31740.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31740.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27834.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9726.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5168.96,"maximum":18454.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9936.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9652.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":18454.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":18454.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16182.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5168.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":25031.56,"10th_percentile":25031.56,"90th_percentile":25031.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7459.74,"maximum":27002.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14539.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14124.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":27002.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27002.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23679.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4575.6,"maximum":16265.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8758.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8508.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16265.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16265.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14263.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4575.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19139.22,"10th_percentile":19139.22,"90th_percentile":19139.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6626.91,"maximum":25444.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13700.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13309.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25444.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25444.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22312.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6626.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11119.15,"maximum":39056.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":21030.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20429.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":39056.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":39056.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34249.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11119.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11316.33,"10th_percentile":11316.33,"90th_percentile":11316.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18659.67,"10th_percentile":18659.67,"90th_percentile":18659.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1699.67,"10th_percentile":1699.67,"90th_percentile":1699.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17180.48,"10th_percentile":17180.48,"90th_percentile":17180.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6745.98,"maximum":23961.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12902.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12533.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":23961.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":23961.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21012.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6745.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11305.89,"10th_percentile":11305.89,"90th_percentile":11305.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5024.17,"10th_percentile":5024.17,"90th_percentile":5024.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7833.81,"10th_percentile":7833.81,"90th_percentile":7833.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4591.47,"maximum":16286.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8769.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8519.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":16286.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":16286.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":14282.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4591.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12836.41,"maximum":47222.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":25427.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24701.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":47222.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":47222.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":41410.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12836.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9806.08,"maximum":36218.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19502.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18945.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":36218.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":36218.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31761.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9806.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9931.1,"maximum":33079.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17811.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17302.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33079.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33079.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29007.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9931.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7075.4,"maximum":25961.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13979.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13579.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":25961.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25961.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":22766.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7075.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7228.21,"maximum":7228.21,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7228.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58618.16,"maximum":58618.16,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58618.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40459.32,"maximum":40459.32,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40459.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30466.04,"maximum":30466.04,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30466.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43872.66,"maximum":43872.66,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43872.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24197.01,"maximum":24197.01,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24197.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8148.36,"maximum":31707.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17073.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16585.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31707.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31707.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27805.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8148.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8355.41,"maximum":27625.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14875.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14450.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":27625.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27625.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24225.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8355.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9719.42,"maximum":35007.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18850.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18311.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":35007.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":35007.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30699.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9719.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7281.79,"maximum":24993.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":13458.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13073.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":24993.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":24993.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":21917.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7281.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8029.29,"maximum":31764.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":17103.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16615.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":31764.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":31764.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":27854.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8029.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13218.75,"maximum":48646.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26194.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25445.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":48646.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":48646.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42658.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13218.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10033.63,"maximum":34667.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18667.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18133.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":34667.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":34667.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":30401.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10033.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26025.13,"maximum":84581.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":45543.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44242.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":84581.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":84581.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":74171.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26332.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12027.39,"maximum":42720.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":23003.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22346.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":42720.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42720.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37462.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12027.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9085.7,"maximum":33666.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18128.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17610.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":33666.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":33666.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29523.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9085.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12082.96,"maximum":43315.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":23323.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22657.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":43315.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":43315.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":37984.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12082.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6330.11,"10th_percentile":6330.11,"90th_percentile":6330.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":25011.71,"10th_percentile":25011.71,"90th_percentile":25011.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12083.62,"10th_percentile":12083.62,"90th_percentile":12083.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7928.74,"maximum":29290.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":15771.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15320.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":29290.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":29290.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":25685.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7928.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":30943.05,"10th_percentile":30943.05,"90th_percentile":30943.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6313.01,"10th_percentile":6313.01,"90th_percentile":6313.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7929.4,"10th_percentile":7929.4,"90th_percentile":7929.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12925.05,"maximum":48374.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":26047.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25303.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":48374.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":48374.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":42420.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12925.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":82218.74,"maximum":267210.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":143882.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":139771.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":267210.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":267210.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":234323.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82218.74,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":41454.41,"maximum":134726.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":72545.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70472.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":134726.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":134726.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":118145.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41454.41,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17594.64,"maximum":57182.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":30790.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29910.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"fee schedule","standard_charge_dollar":57182.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"fee schedule","standard_charge_dollar":57182.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"fee schedule","standard_charge_dollar":50144.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Valor Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"1 through 10","median_amount":8346.27,"10th_percentile":8346.27,"90th_percentile":9089.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":4331.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"13","median_amount":5872.06,"10th_percentile":3938.79,"90th_percentile":11951.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4874.79,"10th_percentile":3938.79,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":6553.21,"10th_percentile":6553.21,"90th_percentile":6553.21},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13540.04,"10th_percentile":13540.04,"90th_percentile":13540.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3938.79,"10th_percentile":3938.79,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"11","median_amount":4935.43,"10th_percentile":3938.79,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":14678.23,"10th_percentile":14678.23,"90th_percentile":14678.23},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4335.38,"10th_percentile":4331.39,"90th_percentile":4874.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":12004.47,"10th_percentile":12004.47,"90th_percentile":16186.32},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":23709.33,"10th_percentile":23709.33,"90th_percentile":23709.33},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":3942.78,"90th_percentile":4331.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5889.64,"10th_percentile":5889.64,"90th_percentile":5889.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":4215.74,"10th_percentile":2071.72,"90th_percentile":6033.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4331.39,"10th_percentile":4331.39,"90th_percentile":5955.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":86.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7620 Days: 3 Additional Days: 2240] [Normal vag. Del. 2 day stay-Case Rate: 5380 Days: 2 Additional Days: 2240] [Nursery  Level 1- Boarder-Per Diem: 3720] [Nursery  Level 2-Per Diem: 1170] [Nursery  Level 3-Per Diem: 2840] [Nursery  Level 4-NICU-Per Diem: 3270]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":159.85,"10th_percentile":50.0,"90th_percentile":16215.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":191.87,"10th_percentile":191.87,"90th_percentile":191.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":89.35,"10th_percentile":63.39,"90th_percentile":89.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"58","median_amount":108.68,"10th_percentile":76.07,"90th_percentile":14073.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":96.85,"10th_percentile":66.03,"90th_percentile":2648.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":9355.66,"10th_percentile":89.13,"90th_percentile":19175.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":95.33,"10th_percentile":95.33,"90th_percentile":95.33},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":137.09,"10th_percentile":108.69,"90th_percentile":3658.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":53.07,"10th_percentile":50.01,"90th_percentile":80.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"40","median_amount":64.84,"10th_percentile":60.38,"90th_percentile":88.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":250.73,"10th_percentile":107.24,"90th_percentile":250.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":53.87,"10th_percentile":53.87,"90th_percentile":53.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":120.62,"10th_percentile":118.82,"90th_percentile":120.62},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":139.82,"10th_percentile":89.17,"90th_percentile":143.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":143.42,"10th_percentile":102.54,"90th_percentile":20405.38},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":189.44,"10th_percentile":189.44,"90th_percentile":189.44},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":137.64,"10th_percentile":119.22,"90th_percentile":137.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"26","median_amount":65.91,"10th_percentile":63.39,"90th_percentile":95.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":153.6,"10th_percentile":153.6,"90th_percentile":5458.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"92","median_amount":86.24,"10th_percentile":65.71,"90th_percentile":21312.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"12","median_amount":79.17,"10th_percentile":63.01,"90th_percentile":190.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":98.43,"10th_percentile":60.49,"90th_percentile":117.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"79","median_amount":126.55,"10th_percentile":59.34,"90th_percentile":178.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"494","median_amount":122.44,"10th_percentile":67.62,"90th_percentile":129.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"265","median_amount":48.67,"10th_percentile":43.06,"90th_percentile":364.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"22","median_amount":90.15,"10th_percentile":35.49,"90th_percentile":389.03},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"11","median_amount":48.0,"10th_percentile":23.0,"90th_percentile":248.99},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"18","median_amount":69.0,"10th_percentile":51.75,"90th_percentile":173.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"475","median_amount":117.68,"10th_percentile":83.39,"90th_percentile":174.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"15","median_amount":70.2,"10th_percentile":62.1,"90th_percentile":1025.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128.89,"10th_percentile":126.55,"90th_percentile":128.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"51","median_amount":83.39,"10th_percentile":69.0,"90th_percentile":160.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"138","median_amount":124.95,"10th_percentile":58.65,"90th_percentile":453.9},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"65","median_amount":128.89,"10th_percentile":126.55,"90th_percentile":129.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"40","median_amount":54.6,"10th_percentile":49.14,"90th_percentile":384.11},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":252.0,"10th_percentile":252.0,"90th_percentile":274.0},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":128.89,"10th_percentile":89.69,"90th_percentile":142.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":195.64,"10th_percentile":153.0,"90th_percentile":291.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":44.85,"10th_percentile":40.36,"90th_percentile":670.8},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":69.0,"10th_percentile":69.0,"90th_percentile":69.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":204.0,"10th_percentile":204.0,"90th_percentile":204.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"29","median_amount":69.0,"10th_percentile":69.0,"90th_percentile":204.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"771","median_amount":132.3,"10th_percentile":62.1,"90th_percentile":311.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"67","median_amount":85.23,"10th_percentile":69.0,"90th_percentile":186.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"258","median_amount":103.12,"10th_percentile":57.55,"90th_percentile":128.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":108.75,"10th_percentile":108.75,"90th_percentile":108.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"27","median_amount":253.11,"10th_percentile":98.79,"90th_percentile":784.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":133.36,"10th_percentile":133.36,"90th_percentile":133.36},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":157.26,"10th_percentile":157.26,"90th_percentile":157.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":154.95,"10th_percentile":102.2,"90th_percentile":323.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"49","median_amount":127.35,"10th_percentile":85.23,"90th_percentile":218.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":754.2,"10th_percentile":754.2,"90th_percentile":1327.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":749.9,"10th_percentile":749.9,"90th_percentile":864.88},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":262.5,"10th_percentile":262.5,"90th_percentile":262.5},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"12","median_amount":114.32,"10th_percentile":85.23,"90th_percentile":154.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":598.22,"10th_percentile":598.22,"90th_percentile":598.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"19","median_amount":337.5,"10th_percentile":209.06,"90th_percentile":986.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":149.31,"10th_percentile":109.31,"90th_percentile":277.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22.47,"10th_percentile":22.47,"90th_percentile":22.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"20","median_amount":627.8,"10th_percentile":133.99,"90th_percentile":1147.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"29","median_amount":160.38,"10th_percentile":78.08,"90th_percentile":348.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"184","median_amount":544.22,"10th_percentile":164.03,"90th_percentile":1163.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"20","median_amount":382.63,"10th_percentile":170.89,"90th_percentile":808.53},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":334.58,"10th_percentile":282.73,"90th_percentile":1326.57},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"43","median_amount":282.82,"10th_percentile":169.02,"90th_percentile":371.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"108","median_amount":156.82,"10th_percentile":85.23,"90th_percentile":377.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"443","median_amount":154.95,"10th_percentile":86.85,"90th_percentile":282.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"30","median_amount":657.0,"10th_percentile":389.1,"90th_percentile":1811.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":158.38,"10th_percentile":158.38,"90th_percentile":158.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"67","median_amount":154.95,"10th_percentile":85.23,"90th_percentile":233.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"11","median_amount":1041.6,"10th_percentile":250.0,"90th_percentile":1675.72},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":84.72,"10th_percentile":84.72,"90th_percentile":84.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"25","median_amount":635.22,"10th_percentile":313.8,"90th_percentile":1736.0},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":1615.38,"10th_percentile":1615.38,"90th_percentile":1615.38},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":266.94,"10th_percentile":266.94,"90th_percentile":266.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":448.82,"10th_percentile":448.82,"90th_percentile":448.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":9504.31,"10th_percentile":9504.31,"90th_percentile":9504.31},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":51.73,"10th_percentile":51.73,"90th_percentile":51.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":308.31,"10th_percentile":36.35,"90th_percentile":460.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":455.32,"10th_percentile":298.21,"90th_percentile":499.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"218","median_amount":709.7,"10th_percentile":177.8,"90th_percentile":1758.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"50","median_amount":169.02,"10th_percentile":92.97,"90th_percentile":397.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"28","median_amount":83.56,"10th_percentile":58.71,"90th_percentile":302.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"48","median_amount":1391.48,"10th_percentile":635.0,"90th_percentile":2905.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"85","median_amount":279.13,"10th_percentile":169.13,"90th_percentile":583.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"87","median_amount":176.78,"10th_percentile":109.31,"90th_percentile":532.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"1 through 10","median_amount":1289.17,"10th_percentile":1289.17,"90th_percentile":1289.17},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"386","median_amount":1094.07,"10th_percentile":446.22,"90th_percentile":2236.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"29","median_amount":1468.8,"10th_percentile":367.33,"90th_percentile":3911.79},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":279.13,"10th_percentile":257.2,"90th_percentile":413.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"77","median_amount":1239.0,"10th_percentile":686.72,"90th_percentile":2439.78},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":10408.02,"10th_percentile":10408.02,"90th_percentile":10408.02},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":286.16,"10th_percentile":279.13,"90th_percentile":912.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":753.41,"10th_percentile":753.41,"90th_percentile":753.41},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":805.35,"10th_percentile":390.72,"90th_percentile":1225.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":260.79,"10th_percentile":260.79,"90th_percentile":260.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"93","median_amount":176.78,"10th_percentile":113.75,"90th_percentile":664.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"38","median_amount":3197.7,"10th_percentile":1300.79,"90th_percentile":7519.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2650.62,"10th_percentile":2650.62,"90th_percentile":2650.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":707.39,"10th_percentile":707.39,"90th_percentile":707.39},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"81","median_amount":452.76,"10th_percentile":181.84,"90th_percentile":1179.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"92","median_amount":2394.83,"10th_percentile":1352.04,"90th_percentile":4787.43},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":4494.2,"10th_percentile":4494.2,"90th_percentile":4494.2},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":652.66,"10th_percentile":425.91,"90th_percentile":1314.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1309.84,"10th_percentile":712.83,"90th_percentile":4236.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2700.1,"10th_percentile":1457.01,"90th_percentile":4023.69},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1715.66,"10th_percentile":1715.66,"90th_percentile":1715.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":2163.26,"10th_percentile":2163.26,"90th_percentile":2163.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"12","median_amount":1684.69,"10th_percentile":1238.52,"90th_percentile":2649.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":497.8,"10th_percentile":497.8,"90th_percentile":497.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"555","median_amount":3293.11,"10th_percentile":1485.14,"90th_percentile":7048.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"90","median_amount":649.47,"10th_percentile":190.4,"90th_percentile":1216.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"185","median_amount":694.47,"10th_percentile":361.14,"90th_percentile":2522.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"16","median_amount":5720.82,"10th_percentile":1852.89,"90th_percentile":9152.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"100","median_amount":1259.1,"10th_percentile":632.85,"90th_percentile":2663.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"153","median_amount":3725.12,"10th_percentile":2279.4,"90th_percentile":5647.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"15","median_amount":2276.83,"10th_percentile":1258.74,"90th_percentile":5726.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":3213.6,"10th_percentile":3213.6,"90th_percentile":5036.03},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"21","median_amount":2068.41,"10th_percentile":1306.26,"90th_percentile":2480.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"33","median_amount":719.26,"10th_percentile":319.25,"90th_percentile":1629.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"202","median_amount":839.7,"10th_percentile":256.79,"90th_percentile":1492.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"16","median_amount":5998.8,"10th_percentile":3460.55,"90th_percentile":11866.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1609.13,"10th_percentile":1609.13,"90th_percentile":1609.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"31","median_amount":753.73,"10th_percentile":238.24,"90th_percentile":1248.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"21","median_amount":6109.16,"10th_percentile":3736.05,"90th_percentile":9390.3},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1159.1,"10th_percentile":863.27,"90th_percentile":2654.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"20","median_amount":4449.03,"10th_percentile":2778.61,"90th_percentile":11173.3},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":2730.66,"10th_percentile":2730.66,"90th_percentile":2730.66},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":994.6,"10th_percentile":809.4,"90th_percentile":2650.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1661.2,"10th_percentile":1528.65,"90th_percentile":2488.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"49","median_amount":733.94,"10th_percentile":256.79,"90th_percentile":1353.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2909.4,"10th_percentile":2060.18,"90th_percentile":10898.27},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":3071.3,"10th_percentile":3071.3,"90th_percentile":3071.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":2839.58,"10th_percentile":2839.58,"90th_percentile":3491.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"149","median_amount":5774.09,"10th_percentile":2918.7,"90th_percentile":9842.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"29","median_amount":758.59,"10th_percentile":344.15,"90th_percentile":1365.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"97","median_amount":1074.9,"10th_percentile":669.64,"90th_percentile":2553.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":2117.54,"10th_percentile":2117.54,"90th_percentile":2117.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":3260.75,"10th_percentile":3260.75,"90th_percentile":3260.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":7350.06,"10th_percentile":4240.08,"90th_percentile":7916.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1656.21,"10th_percentile":1656.21,"90th_percentile":1656.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7497.15,"10th_percentile":7497.15,"90th_percentile":7497.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1277.27,"10th_percentile":1277.27,"90th_percentile":1277.27},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":2912.09,"10th_percentile":2912.09,"90th_percentile":2912.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1886.1,"10th_percentile":1886.1,"90th_percentile":1886.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1906.43,"10th_percentile":1906.43,"90th_percentile":1906.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":14505.33,"10th_percentile":14505.33,"90th_percentile":14505.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":253.93,"10th_percentile":253.93,"90th_percentile":253.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1440.43,"10th_percentile":1440.43,"90th_percentile":1440.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1442.31,"10th_percentile":1442.31,"90th_percentile":1442.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":7569.26,"10th_percentile":7569.26,"90th_percentile":7569.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2379.98,"10th_percentile":2379.98,"90th_percentile":2469.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"11","median_amount":502.24,"10th_percentile":502.24,"90th_percentile":1417.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"47","median_amount":190.78,"10th_percentile":103.12,"90th_percentile":328.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"58","median_amount":364.42,"10th_percentile":364.42,"90th_percentile":1220.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":265.72,"10th_percentile":265.72,"90th_percentile":1502.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":159.59,"10th_percentile":159.59,"90th_percentile":159.59},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":354.88,"10th_percentile":314.88,"90th_percentile":510.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"15","median_amount":303.92,"10th_percentile":236.7,"90th_percentile":355.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"92","median_amount":303.92,"10th_percentile":236.7,"90th_percentile":418.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2629.32,"10th_percentile":2629.32,"90th_percentile":2629.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1177.32,"10th_percentile":1177.32,"90th_percentile":1177.32},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":620.5,"10th_percentile":496.4,"90th_percentile":790.5},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":169.12,"10th_percentile":169.12,"90th_percentile":169.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1503.43,"10th_percentile":747.51,"90th_percentile":1553.9},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":408.8,"10th_percentile":408.8,"90th_percentile":408.8},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.42,"10th_percentile":164.42,"90th_percentile":164.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":299.75,"10th_percentile":236.7,"90th_percentile":711.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1238.52,"10th_percentile":1238.52,"90th_percentile":1238.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"113","median_amount":525.6,"10th_percentile":468.9,"90th_percentile":1931.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"28","median_amount":290.56,"10th_percentile":236.7,"90th_percentile":385.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"28","median_amount":199.55,"10th_percentile":154.43,"90th_percentile":278.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"27","median_amount":1115.42,"10th_percentile":915.9,"90th_percentile":1745.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"180","median_amount":400.09,"10th_percentile":319.67,"90th_percentile":528.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":385.04,"10th_percentile":303.92,"90th_percentile":412.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"1 through 10","median_amount":560.47,"10th_percentile":560.47,"90th_percentile":560.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"198","median_amount":664.56,"10th_percentile":615.3,"90th_percentile":1693.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"37","median_amount":484.58,"10th_percentile":339.21,"90th_percentile":484.58},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"64","median_amount":581.64,"10th_percentile":499.49,"90th_percentile":713.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"48","median_amount":389.08,"10th_percentile":303.92,"90th_percentile":711.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"154","median_amount":389.08,"10th_percentile":290.56,"90th_percentile":790.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1484.1,"10th_percentile":1008.5,"90th_percentile":22025.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":446.87,"10th_percentile":389.08,"90th_percentile":472.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"14","median_amount":1199.35,"10th_percentile":905.25,"90th_percentile":1199.35},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":528.49,"10th_percentile":399.59,"90th_percentile":528.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":675.21,"10th_percentile":675.21,"90th_percentile":1899.8},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":745.5,"10th_percentile":745.5,"90th_percentile":896.0},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":529.18,"10th_percentile":529.18,"90th_percentile":529.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"33","median_amount":395.72,"10th_percentile":303.92,"90th_percentile":803.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"192","median_amount":1229.53,"10th_percentile":855.9,"90th_percentile":2379.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"73","median_amount":395.72,"10th_percentile":303.92,"90th_percentile":711.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"139","median_amount":399.59,"10th_percentile":128.89,"90th_percentile":514.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":1723.44,"10th_percentile":1723.44,"90th_percentile":1723.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":727.79,"10th_percentile":727.79,"90th_percentile":3246.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":812.92,"10th_percentile":741.81,"90th_percentile":1386.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":528.07,"10th_percentile":528.07,"90th_percentile":528.07},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":5794.79,"10th_percentile":5794.79,"90th_percentile":5794.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":880.27,"10th_percentile":880.27,"90th_percentile":880.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":826.46,"10th_percentile":419.13,"90th_percentile":887.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":21421.44,"10th_percentile":21421.44,"90th_percentile":21421.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":458.87,"10th_percentile":458.87,"90th_percentile":458.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2762.1,"10th_percentile":2331.9,"90th_percentile":3519.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"15","median_amount":776.57,"10th_percentile":592.89,"90th_percentile":940.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":5299.56,"10th_percentile":5299.56,"90th_percentile":5299.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1867.09,"10th_percentile":1867.09,"90th_percentile":1867.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"15","median_amount":3135.6,"10th_percentile":3007.06,"90th_percentile":6678.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"12","median_amount":422.28,"10th_percentile":91.8,"90th_percentile":2075.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1795.2,"10th_percentile":1463.6,"90th_percentile":6951.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":19544.44,"10th_percentile":19544.44,"90th_percentile":19544.44},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1867.09,"10th_percentile":1867.09,"90th_percentile":1867.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1867.09,"10th_percentile":1867.09,"90th_percentile":1958.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":37877.06,"10th_percentile":37877.06,"90th_percentile":37877.06},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":25022.44,"10th_percentile":25022.44,"90th_percentile":25022.44},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"25","median_amount":11449.8,"10th_percentile":7424.1,"90th_percentile":29112.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1867.09,"10th_percentile":1867.09,"90th_percentile":1867.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10686.06,"10th_percentile":10686.06,"90th_percentile":10686.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":22266.0,"10th_percentile":18950.4,"90th_percentile":34609.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":45841.05,"10th_percentile":45841.05,"90th_percentile":45841.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1982.6,"10th_percentile":1982.6,"90th_percentile":1982.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":17645.84,"10th_percentile":17645.84,"90th_percentile":17645.84},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":13669.6,"10th_percentile":13669.6,"90th_percentile":13669.6},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":33881.85,"10th_percentile":33881.85,"90th_percentile":33881.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5520.64,"10th_percentile":5520.64,"90th_percentile":5520.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":2352.1,"10th_percentile":2352.1,"90th_percentile":5156.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":704.41,"10th_percentile":704.26,"90th_percentile":869.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":494.84,"10th_percentile":494.84,"90th_percentile":494.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":1367.19,"10th_percentile":1164.99,"90th_percentile":17533.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":488.91,"10th_percentile":488.91,"90th_percentile":488.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":562.95,"10th_percentile":316.59,"90th_percentile":711.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":938.39,"10th_percentile":938.39,"90th_percentile":938.39},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":488.91,"10th_percentile":488.91,"90th_percentile":488.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1867.09,"10th_percentile":1867.09,"90th_percentile":1867.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":494.84,"10th_percentile":494.84,"90th_percentile":494.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4404.96,"10th_percentile":4404.96,"90th_percentile":4404.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":494.84,"10th_percentile":494.84,"90th_percentile":494.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":3904.05,"10th_percentile":2111.4,"90th_percentile":29988.79},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1027.51,"10th_percentile":1027.51,"90th_percentile":1027.51},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1629.98,"10th_percentile":1629.98,"90th_percentile":5345.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":494.84,"10th_percentile":494.84,"90th_percentile":494.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":2025.53,"10th_percentile":2025.53,"90th_percentile":2025.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3806.75,"10th_percentile":1251.2,"90th_percentile":9600.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":488.91,"10th_percentile":488.91,"90th_percentile":488.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":708.69,"10th_percentile":562.95,"90th_percentile":711.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":6663.43,"10th_percentile":4018.34,"90th_percentile":12727.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":1633.97,"10th_percentile":1621.8,"90th_percentile":2115.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1377.21,"10th_percentile":1377.21,"90th_percentile":1377.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"16","median_amount":5200.02,"10th_percentile":2900.66,"90th_percentile":24611.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1587.07,"10th_percentile":1580.78,"90th_percentile":1704.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":3143.52,"10th_percentile":3143.52,"90th_percentile":3143.52},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1316.67,"10th_percentile":1316.67,"90th_percentile":1316.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"12","median_amount":1347.86,"10th_percentile":792.37,"90th_percentile":2178.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1347.86,"10th_percentile":1347.86,"90th_percentile":1347.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":14099.02,"10th_percentile":14099.02,"90th_percentile":30963.52},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":25960.42,"10th_percentile":25960.42,"90th_percentile":25960.42},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":744.28,"10th_percentile":744.28,"90th_percentile":744.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":4712.62,"10th_percentile":4712.62,"90th_percentile":4712.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"25","median_amount":10301.54,"10th_percentile":5068.8,"90th_percentile":22022.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2055.51,"10th_percentile":2055.51,"90th_percentile":2055.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1620.48,"10th_percentile":1296.38,"90th_percentile":2289.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":6093.52,"10th_percentile":6093.52,"90th_percentile":7103.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":14304.68,"10th_percentile":10864.44,"90th_percentile":23983.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2113.83,"10th_percentile":2113.83,"90th_percentile":2113.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2289.98,"10th_percentile":2289.98,"90th_percentile":2289.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":16958.83,"10th_percentile":16958.83,"90th_percentile":16958.83},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2099.72,"10th_percentile":2099.72,"90th_percentile":2099.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":21135.52,"10th_percentile":21135.52,"90th_percentile":21135.52},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":26565.93,"10th_percentile":17703.87,"90th_percentile":34090.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2242.15,"10th_percentile":2242.15,"90th_percentile":2242.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":21048.12,"10th_percentile":21048.12,"90th_percentile":21048.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":8476.02,"10th_percentile":8476.02,"90th_percentile":8476.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5869.94,"10th_percentile":5869.94,"90th_percentile":5869.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":26235.76,"10th_percentile":26235.76,"90th_percentile":26235.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3677.95,"10th_percentile":3677.95,"90th_percentile":3677.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1311.33,"10th_percentile":1311.33,"90th_percentile":1311.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2875.57,"10th_percentile":2875.57,"90th_percentile":2875.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":25913.63,"10th_percentile":25913.63,"90th_percentile":25913.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2919.2,"10th_percentile":2919.2,"90th_percentile":2919.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":55569.93,"10th_percentile":51993.97,"90th_percentile":85997.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":10620.37,"10th_percentile":10620.37,"90th_percentile":10620.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12342.14,"10th_percentile":12342.14,"90th_percentile":12342.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":44686.5,"10th_percentile":44686.5,"90th_percentile":44686.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":10764.53,"10th_percentile":10764.53,"90th_percentile":10764.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":10620.37,"10th_percentile":10311.53,"90th_percentile":10620.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":10173.71,"10th_percentile":10173.71,"90th_percentile":10173.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":97971.05,"10th_percentile":97971.05,"90th_percentile":97971.05},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":39139.34,"10th_percentile":39139.34,"90th_percentile":39139.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":10602.61,"10th_percentile":10602.61,"90th_percentile":11313.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":144265.88,"10th_percentile":112645.18,"90th_percentile":188415.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"13","median_amount":197.52,"10th_percentile":189.38,"90th_percentile":287.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":644.6,"10th_percentile":280.18,"90th_percentile":944.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"37","median_amount":200.74,"10th_percentile":191.92,"90th_percentile":418.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":202.42,"10th_percentile":123.51,"90th_percentile":287.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1342.61,"10th_percentile":1342.61,"90th_percentile":1342.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":154.95,"10th_percentile":154.95,"90th_percentile":154.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":133.83,"10th_percentile":133.83,"90th_percentile":225.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":314.3,"10th_percentile":314.3,"90th_percentile":314.3},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"36","median_amount":292.54,"10th_percentile":191.92,"90th_percentile":465.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":483.84,"10th_percentile":483.84,"90th_percentile":1574.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"11","median_amount":200.74,"10th_percentile":191.92,"90th_percentile":200.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128.89,"10th_percentile":126.24,"90th_percentile":189.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":487.06,"10th_percentile":487.06,"90th_percentile":487.06},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":2320.73,"10th_percentile":1697.08,"90th_percentile":21217.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1314.81,"10th_percentile":1314.81,"90th_percentile":1314.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":13379.0,"10th_percentile":13379.0,"90th_percentile":13379.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":375.06,"10th_percentile":375.06,"90th_percentile":375.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":567.77,"10th_percentile":567.77,"90th_percentile":567.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4579.38,"10th_percentile":4579.38,"90th_percentile":4579.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":6669.57,"10th_percentile":6669.57,"90th_percentile":6965.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":1492.84,"10th_percentile":1383.14,"90th_percentile":3098.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1419.5,"10th_percentile":1419.5,"90th_percentile":1419.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"21","median_amount":11830.49,"10th_percentile":4210.24,"90th_percentile":16932.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1478.54,"10th_percentile":1280.52,"90th_percentile":12973.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":4615.74,"10th_percentile":4615.74,"90th_percentile":4615.74},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1484.78,"10th_percentile":1484.78,"90th_percentile":1484.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"11","median_amount":1515.4,"10th_percentile":1484.78,"90th_percentile":2177.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3670.43,"10th_percentile":3670.43,"90th_percentile":3670.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1484.78,"10th_percentile":1484.78,"90th_percentile":1484.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2913.93,"10th_percentile":2913.93,"90th_percentile":2913.93},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":5679.79,"10th_percentile":5679.79,"90th_percentile":5679.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"19","median_amount":14058.69,"10th_percentile":2733.18,"90th_percentile":40147.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2177.56,"10th_percentile":2177.56,"90th_percentile":2177.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1280.52,"10th_percentile":1193.95,"90th_percentile":1280.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":52598.3,"10th_percentile":52598.3,"90th_percentile":52598.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":3245.08,"10th_percentile":2931.48,"90th_percentile":7152.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"41","median_amount":18981.85,"10th_percentile":9645.14,"90th_percentile":27444.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4579.38,"10th_percentile":3017.05,"90th_percentile":5321.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3252.98,"10th_percentile":2596.07,"90th_percentile":14226.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":9534.38,"10th_percentile":9534.38,"90th_percentile":9534.38},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"19","median_amount":3088.99,"10th_percentile":2327.64,"90th_percentile":6780.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":25105.39,"10th_percentile":24449.74,"90th_percentile":53448.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2327.64,"10th_percentile":2327.64,"90th_percentile":2327.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"17","median_amount":27218.98,"10th_percentile":24259.07,"90th_percentile":46793.92},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":23272.7,"10th_percentile":22921.28,"90th_percentile":44771.05},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":12758.5,"10th_percentile":12758.5,"90th_percentile":12758.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2446.08,"10th_percentile":2446.08,"90th_percentile":4579.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":5455.42,"10th_percentile":5455.42,"90th_percentile":5455.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":9437.23,"10th_percentile":9187.23,"90th_percentile":36640.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"40","median_amount":28194.53,"10th_percentile":16316.78,"90th_percentile":48608.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4579.38,"10th_percentile":3155.81,"90th_percentile":5525.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3250.58,"10th_percentile":2761.64,"90th_percentile":5611.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":45667.92,"10th_percentile":33417.81,"90th_percentile":51107.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":9181.74,"10th_percentile":8526.83,"90th_percentile":13276.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"31","median_amount":33469.35,"10th_percentile":17894.92,"90th_percentile":48281.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":18791.31,"10th_percentile":11944.99,"90th_percentile":29863.39},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":12132.93,"10th_percentile":12132.93,"90th_percentile":12132.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5525.96,"10th_percentile":4378.03,"90th_percentile":6780.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":83033.67,"10th_percentile":83033.67,"90th_percentile":83033.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":58213.02,"10th_percentile":43085.85,"90th_percentile":95153.04},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":29037.41,"10th_percentile":29037.41,"90th_percentile":58322.5},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5542.87,"10th_percentile":5542.87,"90th_percentile":5542.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":21088.39,"10th_percentile":21088.39,"90th_percentile":21088.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":19006.4,"10th_percentile":19006.4,"90th_percentile":19006.4},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"22","median_amount":45784.69,"10th_percentile":37705.49,"90th_percentile":67231.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4579.38,"10th_percentile":4579.38,"90th_percentile":4579.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4746.6,"10th_percentile":4746.6,"90th_percentile":4746.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":13067.78,"10th_percentile":13034.66,"90th_percentile":13546.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":11720.33,"10th_percentile":11720.33,"90th_percentile":11720.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":41480.41,"10th_percentile":38081.15,"90th_percentile":42637.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":26484.19,"10th_percentile":26484.19,"90th_percentile":26860.04},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":23560.62,"10th_percentile":23560.62,"90th_percentile":23560.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":12030.09,"10th_percentile":12030.09,"90th_percentile":12030.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":13533.09,"10th_percentile":13533.09,"90th_percentile":13533.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6780.61,"10th_percentile":6780.61,"90th_percentile":6780.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":49311.56,"10th_percentile":49311.56,"90th_percentile":70468.52},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12799.46,"10th_percentile":12799.46,"90th_percentile":12799.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":61559.41,"10th_percentile":61559.41,"90th_percentile":61559.41},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":37716.07,"10th_percentile":37716.07,"90th_percentile":37716.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":57526.38,"10th_percentile":43936.11,"90th_percentile":75075.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5198.54,"10th_percentile":5198.54,"90th_percentile":5198.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12804.92,"10th_percentile":10444.0,"90th_percentile":13016.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":18014.18,"10th_percentile":18014.18,"90th_percentile":18014.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":57120.13,"10th_percentile":57120.13,"90th_percentile":57120.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":19508.71,"10th_percentile":19508.71,"90th_percentile":19508.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":19751.62,"10th_percentile":19751.62,"90th_percentile":19751.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":53119.56,"10th_percentile":53119.56,"90th_percentile":53119.56},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":46969.09,"10th_percentile":46969.09,"90th_percentile":46969.09},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":60480.61,"10th_percentile":60480.61,"90th_percentile":60480.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14846.47,"10th_percentile":14846.47,"90th_percentile":14846.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":7932.86,"10th_percentile":7932.86,"90th_percentile":7932.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1194.19,"10th_percentile":1194.19,"90th_percentile":1194.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1468.64,"10th_percentile":1468.64,"90th_percentile":1468.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":24246.49,"10th_percentile":24246.49,"90th_percentile":24246.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Airway Endoscopy","code_information":[{"code":"5152","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":1499.66,"10th_percentile":1499.66,"90th_percentile":1499.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":388.68,"10th_percentile":388.68,"90th_percentile":388.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":388.36,"10th_percentile":324.67,"90th_percentile":396.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":778.96,"10th_percentile":778.96,"90th_percentile":778.96},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":339.21,"10th_percentile":339.21,"90th_percentile":339.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1281.7,"10th_percentile":1281.7,"90th_percentile":1281.7},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1287.94,"10th_percentile":1287.94,"90th_percentile":1287.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1425.58,"10th_percentile":1425.58,"90th_percentile":1425.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1647.9,"10th_percentile":1019.45,"90th_percentile":2060.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":339.21,"10th_percentile":339.21,"90th_percentile":339.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":396.07,"10th_percentile":396.07,"90th_percentile":396.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":27359.95,"10th_percentile":27359.95,"90th_percentile":27359.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1799.74,"10th_percentile":1799.74,"90th_percentile":1799.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2856.45,"10th_percentile":2856.45,"90th_percentile":2856.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1799.74,"10th_percentile":1799.74,"90th_percentile":2699.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1799.74,"10th_percentile":1799.74,"90th_percentile":1799.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":28326.46,"10th_percentile":28326.46,"90th_percentile":28326.46},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":4725.21,"10th_percentile":4725.21,"90th_percentile":4725.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":22453.11,"10th_percentile":22453.11,"90th_percentile":22453.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1526.81,"10th_percentile":1526.81,"90th_percentile":1526.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":24677.5,"10th_percentile":24677.5,"90th_percentile":24677.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":16462.32,"10th_percentile":16462.32,"90th_percentile":16462.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1720.6,"10th_percentile":1720.6,"90th_percentile":1720.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":14096.73,"10th_percentile":14096.73,"90th_percentile":14096.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1791.29,"10th_percentile":1791.29,"90th_percentile":1791.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"11","median_amount":8291.0,"10th_percentile":4859.19,"90th_percentile":17221.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1791.29,"10th_percentile":1791.29,"90th_percentile":1791.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":8473.82,"10th_percentile":8473.82,"90th_percentile":8473.82},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"16","median_amount":1791.29,"10th_percentile":1194.19,"90th_percentile":2718.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":12245.79,"10th_percentile":12245.79,"90th_percentile":12245.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1791.29,"10th_percentile":1791.29,"90th_percentile":1791.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":15215.87,"10th_percentile":15215.87,"90th_percentile":16712.44},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":6997.47,"10th_percentile":6997.47,"90th_percentile":6997.47},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1791.29,"10th_percentile":1791.29,"90th_percentile":2686.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":4779.94,"10th_percentile":4779.94,"90th_percentile":4779.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":4245.76,"10th_percentile":4245.76,"90th_percentile":4245.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":14517.67,"10th_percentile":10643.54,"90th_percentile":19099.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1791.29,"10th_percentile":1791.29,"90th_percentile":1791.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2594.83,"10th_percentile":2594.83,"90th_percentile":2594.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":18395.91,"10th_percentile":18395.91,"90th_percentile":18395.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":10556.5,"10th_percentile":10556.5,"90th_percentile":10556.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":21142.67,"10th_percentile":12827.91,"90th_percentile":29746.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3925.92,"10th_percentile":3925.92,"90th_percentile":3925.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6536.37,"10th_percentile":3249.45,"90th_percentile":6931.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3925.92,"10th_percentile":3925.92,"90th_percentile":3925.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":40355.19,"10th_percentile":40355.19,"90th_percentile":40355.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":36178.44,"10th_percentile":24469.07,"90th_percentile":49312.12},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":32904.19,"10th_percentile":32904.19,"90th_percentile":32904.19},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":22568.38,"10th_percentile":22568.38,"90th_percentile":22568.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"18","median_amount":37860.87,"10th_percentile":18315.0,"90th_percentile":63607.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":20399.45,"10th_percentile":20399.45,"90th_percentile":20399.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1823.19,"10th_percentile":1823.19,"90th_percentile":2718.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":16795.76,"10th_percentile":16795.76,"90th_percentile":16795.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":60628.05,"10th_percentile":60628.05,"90th_percentile":60628.05},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":28103.28,"10th_percentile":28103.28,"90th_percentile":28103.28},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":30792.49,"10th_percentile":30792.49,"90th_percentile":30792.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1247.87,"10th_percentile":1247.87,"90th_percentile":1247.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":7505.59,"10th_percentile":7505.59,"90th_percentile":7505.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1242.93,"10th_percentile":1242.93,"90th_percentile":1242.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1480.67,"10th_percentile":1480.67,"90th_percentile":1480.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1459.6,"10th_percentile":1459.6,"90th_percentile":1459.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1699.2,"10th_percentile":1473.3,"90th_percentile":9677.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":3051.42,"10th_percentile":3051.42,"90th_percentile":3147.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":22817.96,"10th_percentile":22817.96,"90th_percentile":22817.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3147.96,"10th_percentile":3051.42,"90th_percentile":3275.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2967.09,"10th_percentile":2967.09,"90th_percentile":2967.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":8919.04,"10th_percentile":8919.04,"90th_percentile":8919.04},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2419.31,"10th_percentile":2419.31,"90th_percentile":2419.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":26978.29,"10th_percentile":26978.29,"90th_percentile":26978.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3040.16,"10th_percentile":3040.16,"90th_percentile":3040.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":3224.38,"10th_percentile":3224.38,"90th_percentile":3224.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":15926.31,"10th_percentile":8537.8,"90th_percentile":19587.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3223.08,"10th_percentile":3216.88,"90th_percentile":3243.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":4932.45,"10th_percentile":4932.45,"90th_percentile":4932.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":5767.86,"10th_percentile":5767.86,"90th_percentile":5767.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3346.21,"10th_percentile":3346.21,"90th_percentile":3346.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3141.6,"10th_percentile":3141.6,"90th_percentile":3141.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":11302.09,"10th_percentile":11302.09,"90th_percentile":11302.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":32016.48,"10th_percentile":25471.12,"90th_percentile":55078.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5672.81,"10th_percentile":5672.81,"90th_percentile":5672.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":28556.26,"10th_percentile":28556.26,"90th_percentile":28556.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":11014.72,"10th_percentile":11014.72,"90th_percentile":11014.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":10602.66,"10th_percentile":10602.66,"90th_percentile":10602.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11363.24,"10th_percentile":11363.24,"90th_percentile":11363.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9936.6,"10th_percentile":9936.6,"90th_percentile":9936.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":45026.19,"10th_percentile":45026.19,"90th_percentile":45026.19},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":49365.05,"10th_percentile":48480.51,"90th_percentile":68882.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15792.1,"10th_percentile":15792.1,"90th_percentile":15792.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":8328.9,"10th_percentile":8328.9,"90th_percentile":8328.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":28738.52,"10th_percentile":28738.52,"90th_percentile":28738.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":10099.34,"10th_percentile":10099.34,"90th_percentile":10099.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10060.16,"10th_percentile":10060.16,"90th_percentile":10060.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":6140.4,"10th_percentile":6140.4,"90th_percentile":6140.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":1264.87,"10th_percentile":905.2,"90th_percentile":1696.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3004.55,"10th_percentile":3004.55,"90th_percentile":3004.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":5485.27,"10th_percentile":1990.24,"90th_percentile":48934.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1290.93,"10th_percentile":1290.93,"90th_percentile":1290.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1815.88,"10th_percentile":1815.88,"90th_percentile":1815.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1259.55,"10th_percentile":1259.55,"90th_percentile":1259.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1652.16,"10th_percentile":1652.16,"90th_percentile":1652.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1046.65,"10th_percentile":1046.65,"90th_percentile":1046.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4871.12,"10th_percentile":4871.12,"90th_percentile":8680.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":909.07,"10th_percentile":909.07,"90th_percentile":909.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1846.27,"10th_percentile":1122.67,"90th_percentile":12795.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":2884.78,"10th_percentile":2873.6,"90th_percentile":4566.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":1393.61,"10th_percentile":945.19,"90th_percentile":1648.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"42","median_amount":3424.54,"10th_percentile":1151.28,"90th_percentile":5339.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1702.17,"10th_percentile":1131.41,"90th_percentile":4939.23},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":3527.26,"10th_percentile":3527.26,"90th_percentile":3527.26},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1674.47,"10th_percentile":1674.47,"90th_percentile":1674.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":991.68,"10th_percentile":991.68,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"27","median_amount":991.68,"10th_percentile":991.68,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4930.02,"10th_percentile":4876.75,"90th_percentile":6575.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"11","median_amount":5157.8,"10th_percentile":4356.93,"90th_percentile":8767.92},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1648.08,"10th_percentile":944.9,"90th_percentile":1648.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":4422.47,"10th_percentile":2935.1,"90th_percentile":8165.41},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":5435.43,"10th_percentile":5435.43,"90th_percentile":6963.73},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":4052.87,"10th_percentile":2523.65,"90th_percentile":4792.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"45","median_amount":5721.99,"10th_percentile":3425.4,"90th_percentile":7339.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1400.14,"10th_percentile":731.01,"90th_percentile":2237.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":2373.28,"10th_percentile":2373.28,"90th_percentile":2373.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":1903.66,"10th_percentile":1825.58,"90th_percentile":1904.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":991.68,"10th_percentile":991.68,"90th_percentile":991.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"14","median_amount":2230.65,"10th_percentile":2083.36,"90th_percentile":6705.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1905.17,"10th_percentile":1510.17,"90th_percentile":1905.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":991.68,"10th_percentile":991.68,"90th_percentile":991.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":991.68,"10th_percentile":991.68,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1555.7,"10th_percentile":1555.7,"90th_percentile":1555.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":8729.67,"10th_percentile":8729.67,"90th_percentile":8729.67},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1569.48,"10th_percentile":1569.48,"90th_percentile":1569.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":991.68,"10th_percentile":991.68,"90th_percentile":991.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1457.27,"10th_percentile":1457.27,"90th_percentile":1457.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":5137.59,"10th_percentile":5137.59,"90th_percentile":7579.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":4522.74,"10th_percentile":4120.26,"90th_percentile":4564.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"26","median_amount":911.84,"10th_percentile":911.84,"90th_percentile":911.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"102","median_amount":3246.35,"10th_percentile":3007.25,"90th_percentile":3266.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"14","median_amount":2200.95,"10th_percentile":2055.24,"90th_percentile":2405.46},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1628.29,"10th_percentile":1628.29,"90th_percentile":1818.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":911.84,"10th_percentile":911.84,"90th_percentile":911.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"12","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4681.8,"10th_percentile":4652.1,"90th_percentile":5578.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"41","median_amount":4498.2,"10th_percentile":4470.15,"90th_percentile":4517.61},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":980.19,"10th_percentile":980.19,"90th_percentile":980.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"16","median_amount":3713.64,"10th_percentile":3402.9,"90th_percentile":3727.5},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":3440.98,"10th_percentile":3440.98,"90th_percentile":3440.98},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":2901.6,"10th_percentile":2901.6,"90th_percentile":2901.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":2651.78,"10th_percentile":2544.48,"90th_percentile":3023.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"122","median_amount":4764.44,"10th_percentile":4311.9,"90th_percentile":4786.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":2188.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":911.85,"10th_percentile":911.84,"90th_percentile":911.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":5699.07,"10th_percentile":5155.7,"90th_percentile":9808.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"30","median_amount":1179.25,"10th_percentile":1179.25,"90th_percentile":1768.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"77","median_amount":4198.27,"10th_percentile":3864.58,"90th_percentile":5206.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":1179.24,"10th_percentile":1129.69,"90th_percentile":1768.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"15","median_amount":2974.27,"10th_percentile":2661.75,"90th_percentile":3243.34},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":2397.85,"10th_percentile":2397.85,"90th_percentile":2397.85},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":2105.79,"10th_percentile":2105.79,"90th_percentile":2105.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"27","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1697.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6132.6,"10th_percentile":5881.5,"90th_percentile":7350.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"32","median_amount":6223.02,"10th_percentile":5642.47,"90th_percentile":6985.3},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1285.61,"10th_percentile":1285.61,"90th_percentile":1960.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"16","median_amount":5043.5,"10th_percentile":4512.38,"90th_percentile":5975.2},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1179.25,"10th_percentile":1179.25,"90th_percentile":1179.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1697.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":4314.83,"10th_percentile":4314.83,"90th_percentile":4314.83},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":4301.84,"10th_percentile":4301.84,"90th_percentile":4301.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":3429.43,"10th_percentile":3285.34,"90th_percentile":3429.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"111","median_amount":6067.08,"10th_percentile":5212.79,"90th_percentile":7151.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1131.41,"10th_percentile":1131.41,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"26","median_amount":1179.25,"10th_percentile":1179.24,"90th_percentile":1768.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":2750.28,"10th_percentile":2750.28,"90th_percentile":2750.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":21497.58,"10th_percentile":21497.58,"90th_percentile":23628.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2750.68,"10th_percentile":2750.68,"90th_percentile":2750.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":16265.63,"10th_percentile":16265.63,"90th_percentile":16265.63},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":29525.9,"10th_percentile":16112.09,"90th_percentile":35900.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":21382.7,"10th_percentile":21382.7,"90th_percentile":32011.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":3725.42,"10th_percentile":3537.07,"90th_percentile":6331.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":19618.22,"10th_percentile":16969.46,"90th_percentile":23296.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3538.45,"10th_percentile":3538.45,"90th_percentile":3538.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3096.64,"10th_percentile":3096.64,"90th_percentile":3096.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":26986.2,"10th_percentile":26986.2,"90th_percentile":26986.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4311.29,"10th_percentile":4311.29,"90th_percentile":4311.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3536.76,"10th_percentile":3536.76,"90th_percentile":3536.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":24850.06,"10th_percentile":24850.06,"90th_percentile":24850.06},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3096.64,"10th_percentile":3096.64,"90th_percentile":3096.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":10014.56,"10th_percentile":10014.56,"90th_percentile":10014.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":31403.79,"10th_percentile":23663.64,"90th_percentile":46202.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3311.97,"10th_percentile":3311.97,"90th_percentile":3311.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":44245.67,"10th_percentile":44245.67,"90th_percentile":44245.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4311.29,"10th_percentile":4311.29,"90th_percentile":4311.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":52276.52,"10th_percentile":52276.52,"90th_percentile":52276.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":29396.75,"10th_percentile":22618.8,"90th_percentile":39930.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":5530.95,"10th_percentile":5516.7,"90th_percentile":7990.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"28","median_amount":26487.58,"10th_percentile":12427.63,"90th_percentile":42377.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":16102.24,"10th_percentile":9362.46,"90th_percentile":18837.64},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":10420.01,"10th_percentile":9876.62,"90th_percentile":10421.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3841.99,"10th_percentile":3384.68,"90th_percentile":6499.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"27","median_amount":3841.99,"10th_percentile":3590.19,"90th_percentile":5933.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":21795.84,"10th_percentile":21795.84,"90th_percentile":21795.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":36327.32,"10th_percentile":36327.32,"90th_percentile":36327.32},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3841.99,"10th_percentile":3841.99,"90th_percentile":6116.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":41715.11,"10th_percentile":40179.33,"90th_percentile":51732.03},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8575.16,"10th_percentile":8575.16,"90th_percentile":8575.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3841.99,"10th_percentile":3540.34,"90th_percentile":5310.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":27134.82,"10th_percentile":27134.82,"90th_percentile":27134.82},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":22353.61,"10th_percentile":22353.61,"90th_percentile":22353.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":16969.73,"10th_percentile":16969.73,"90th_percentile":16969.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"27","median_amount":39022.6,"10th_percentile":27643.01,"90th_percentile":52272.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3841.99,"10th_percentile":3841.99,"90th_percentile":5532.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8330.19,"10th_percentile":5843.51,"90th_percentile":9481.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":51398.82,"10th_percentile":51398.82,"90th_percentile":51398.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":35820.96,"10th_percentile":35820.96,"90th_percentile":35820.96},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5740.51,"10th_percentile":5740.51,"90th_percentile":5740.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":8446.27,"10th_percentile":8127.69,"90th_percentile":8446.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":8446.27,"10th_percentile":8446.27,"90th_percentile":8446.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":90052.62,"10th_percentile":90052.62,"90th_percentile":90052.62},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9356.29,"10th_percentile":9356.29,"90th_percentile":9356.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":80027.25,"10th_percentile":63232.98,"90th_percentile":100761.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":2048.81,"10th_percentile":1754.09,"90th_percentile":2056.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2716.17,"10th_percentile":2716.17,"90th_percentile":2716.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"11","median_amount":13120.23,"10th_percentile":10580.61,"90th_percentile":15821.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1433.5,"10th_percentile":1433.5,"90th_percentile":1433.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2048.8,"10th_percentile":2048.8,"90th_percentile":2056.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":8675.3,"10th_percentile":8675.3,"90th_percentile":8675.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1899.73,"10th_percentile":1899.73,"90th_percentile":1899.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":17112.17,"10th_percentile":17112.17,"90th_percentile":17112.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":21561.48,"10th_percentile":21561.48,"90th_percentile":22393.12},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2056.0,"10th_percentile":2056.0,"90th_percentile":2056.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":13324.57,"10th_percentile":13324.57,"90th_percentile":13324.57},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2641.87,"10th_percentile":2641.87,"90th_percentile":2720.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":5958.24,"10th_percentile":5958.24,"90th_percentile":5958.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":20197.86,"10th_percentile":17706.64,"90th_percentile":24445.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1730.3,"10th_percentile":1639.04,"90th_percentile":2048.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"11","median_amount":3453.46,"10th_percentile":3081.96,"90th_percentile":5091.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":16252.89,"10th_percentile":11450.89,"90th_percentile":23586.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2690.9,"10th_percentile":2690.9,"90th_percentile":3318.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3405.44,"10th_percentile":3132.97,"90th_percentile":3457.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":6159.77,"10th_percentile":6159.77,"90th_percentile":6159.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2690.9,"10th_percentile":2667.25,"90th_percentile":3087.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3097.27,"10th_percentile":3097.27,"90th_percentile":3097.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":16480.62,"10th_percentile":16480.62,"90th_percentile":16480.62},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2690.9,"10th_percentile":2690.9,"90th_percentile":3449.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"21","median_amount":25318.81,"10th_percentile":16358.78,"90th_percentile":35939.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2690.9,"10th_percentile":2690.9,"90th_percentile":2690.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3341.67,"10th_percentile":2760.12,"90th_percentile":3351.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":30709.13,"10th_percentile":30709.13,"90th_percentile":30709.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":5089.04,"10th_percentile":5089.04,"90th_percentile":5089.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"12","median_amount":18311.58,"10th_percentile":14604.66,"90th_percentile":20252.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3599.58,"10th_percentile":3599.58,"90th_percentile":3599.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4697.26,"10th_percentile":4697.26,"90th_percentile":4697.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":21041.27,"10th_percentile":21041.27,"90th_percentile":21041.27},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":8732.47,"10th_percentile":8732.47,"90th_percentile":8732.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4844.99,"10th_percentile":4844.99,"90th_percentile":4844.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":41190.24,"10th_percentile":41190.24,"90th_percentile":41190.24},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":21647.43,"10th_percentile":21647.43,"90th_percentile":21647.43},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":16861.39,"10th_percentile":16861.39,"90th_percentile":16861.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"11","median_amount":33096.62,"10th_percentile":27337.36,"90th_percentile":36345.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3599.58,"10th_percentile":3599.58,"90th_percentile":3599.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7823.96,"10th_percentile":7823.96,"90th_percentile":7823.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"33","median_amount":221.88,"10th_percentile":187.5,"90th_percentile":627.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"164","median_amount":161.0,"10th_percentile":128.8,"90th_percentile":562.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"11","median_amount":179.27,"10th_percentile":81.42,"90th_percentile":407.81},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":193.5,"10th_percentile":165.33,"90th_percentile":258.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"27","median_amount":219.85,"10th_percentile":219.85,"90th_percentile":371.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"241","median_amount":219.85,"10th_percentile":219.85,"90th_percentile":389.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"13","median_amount":219.85,"10th_percentile":200.18,"90th_percentile":363.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"46","median_amount":219.3,"10th_percentile":195.5,"90th_percentile":832.15},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"44","median_amount":180.6,"10th_percentile":144.48,"90th_percentile":597.8},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"12","median_amount":219.3,"10th_percentile":219.3,"90th_percentile":501.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"73","median_amount":219.85,"10th_percentile":210.19,"90th_percentile":389.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":258.0,"10th_percentile":258.0,"90th_percentile":258.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"20","median_amount":433.0,"10th_percentile":10.53,"90th_percentile":922.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"196","median_amount":232.2,"10th_percentile":183.6,"90th_percentile":913.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"38","median_amount":219.85,"10th_percentile":219.85,"90th_percentile":380.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":14969.94,"10th_percentile":14969.94,"90th_percentile":14969.94},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1750.41,"10th_percentile":1750.41,"90th_percentile":1750.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":12847.88,"10th_percentile":6599.88,"90th_percentile":15831.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2070.3,"10th_percentile":2070.3,"90th_percentile":2070.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2543.99,"10th_percentile":2543.99,"90th_percentile":2543.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":5282.68,"10th_percentile":5282.68,"90th_percentile":5282.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":16780.59,"10th_percentile":16780.59,"90th_percentile":16780.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1828.69,"10th_percentile":1828.69,"90th_percentile":2165.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":17414.06,"10th_percentile":15252.12,"90th_percentile":24482.75},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":12807.23,"10th_percentile":12807.23,"90th_percentile":12807.23},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":4353.18,"10th_percentile":4353.18,"90th_percentile":4353.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2165.51,"10th_percentile":1750.41,"90th_percentile":2231.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"15","median_amount":20676.19,"10th_percentile":16636.24,"90th_percentile":29661.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2165.51,"10th_percentile":2165.51,"90th_percentile":2165.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2861.5,"10th_percentile":2545.17,"90th_percentile":3185.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":53505.77,"10th_percentile":53505.77,"90th_percentile":53505.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5012.53,"10th_percentile":5012.53,"90th_percentile":5012.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":19255.92,"10th_percentile":16157.83,"90th_percentile":37366.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2165.51,"10th_percentile":2165.51,"90th_percentile":2165.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4042.8,"10th_percentile":3540.34,"90th_percentile":4096.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":45337.03,"10th_percentile":45337.03,"90th_percentile":45337.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5125.55,"10th_percentile":5125.55,"90th_percentile":5125.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":61842.33,"10th_percentile":61842.33,"90th_percentile":61842.33},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":19638.22,"10th_percentile":19638.22,"90th_percentile":19638.22},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2165.51,"10th_percentile":2165.51,"90th_percentile":2165.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":24963.15,"10th_percentile":23331.06,"90th_percentile":28886.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2165.51,"10th_percentile":2165.51,"90th_percentile":2165.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":14057.05,"10th_percentile":14057.05,"90th_percentile":14057.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":1960.55,"10th_percentile":1954.65,"90th_percentile":2012.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2078.33,"10th_percentile":2078.33,"90th_percentile":2737.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"20","median_amount":7586.43,"10th_percentile":6065.74,"90th_percentile":10982.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1385.55,"10th_percentile":1385.55,"90th_percentile":1385.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1853.85,"10th_percentile":1565.95,"90th_percentile":1953.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":7764.29,"10th_percentile":7764.29,"90th_percentile":7764.29},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1385.55,"10th_percentile":1385.55,"90th_percentile":1385.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1385.55,"10th_percentile":1324.63,"90th_percentile":3123.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":13696.94,"10th_percentile":11883.61,"90th_percentile":17117.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2078.33,"10th_percentile":2078.33,"90th_percentile":2078.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":16986.67,"10th_percentile":15512.33,"90th_percentile":21916.1},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1960.25,"10th_percentile":1960.25,"90th_percentile":1960.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":20775.61,"10th_percentile":20775.61,"90th_percentile":20775.61},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1634.55,"10th_percentile":1634.55,"90th_percentile":1634.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":9437.23,"10th_percentile":9437.23,"90th_percentile":9437.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"27","median_amount":15839.88,"10th_percentile":11748.04,"90th_percentile":20810.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1562.44,"10th_percentile":1478.68,"90th_percentile":2233.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":1929.86,"10th_percentile":1929.86,"90th_percentile":1929.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"13","median_amount":295.48,"10th_percentile":236.19,"90th_percentile":590.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":212.35,"10th_percentile":212.35,"90th_percentile":212.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":1295.29,"10th_percentile":1175.12,"90th_percentile":1523.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":333.19,"10th_percentile":333.19,"90th_percentile":333.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":289.24,"10th_percentile":241.3,"90th_percentile":300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":922.29,"10th_percentile":922.29,"90th_percentile":922.29},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":2451.31,"10th_percentile":2451.31,"90th_percentile":2451.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":222.12,"10th_percentile":222.12,"90th_percentile":222.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":222.12,"10th_percentile":222.12,"90th_percentile":970.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":222.12,"10th_percentile":222.12,"90th_percentile":222.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1932.42,"10th_percentile":1907.42,"90th_percentile":2075.72},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":298.39,"10th_percentile":298.39,"90th_percentile":298.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1559.78,"10th_percentile":1559.78,"90th_percentile":1559.78},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":226.83,"10th_percentile":226.83,"90th_percentile":226.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2180.72,"10th_percentile":1919.54,"90th_percentile":2197.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":222.12,"10th_percentile":222.12,"90th_percentile":222.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.73,"10th_percentile":175.73,"90th_percentile":236.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":5987.38,"10th_percentile":5987.38,"90th_percentile":12591.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1691.05,"10th_percentile":1691.05,"90th_percentile":1691.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":469.92,"10th_percentile":469.92,"90th_percentile":586.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1657.85,"10th_percentile":1657.85,"90th_percentile":1657.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":2772.01,"10th_percentile":2772.01,"90th_percentile":2772.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":17318.57,"10th_percentile":16453.02,"90th_percentile":21082.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"30","median_amount":2282.93,"10th_percentile":1824.86,"90th_percentile":2301.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":11099.18,"10th_percentile":10311.91,"90th_percentile":13716.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":2236.57,"10th_percentile":1824.85,"90th_percentile":2288.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":4073.32,"10th_percentile":4073.32,"90th_percentile":4073.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"13","median_amount":1677.72,"10th_percentile":1603.95,"90th_percentile":1710.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":19229.49,"10th_percentile":19229.49,"90th_percentile":19229.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":25079.18,"10th_percentile":25079.18,"90th_percentile":25079.18},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1928.25,"10th_percentile":1928.25,"90th_percentile":2288.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":6633.69,"10th_percentile":6633.69,"90th_percentile":6633.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1791.06,"10th_percentile":1791.06,"90th_percentile":1791.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"11","median_amount":18761.98,"10th_percentile":13377.86,"90th_percentile":21663.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"17","median_amount":1824.85,"10th_percentile":1824.85,"90th_percentile":2286.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Intraocular Procedures","code_information":[{"code":"5493","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":7419.6,"10th_percentile":7419.6,"90th_percentile":7696.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"335","median_amount":88.56,"10th_percentile":70.45,"90th_percentile":129.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"68","median_amount":72.17,"10th_percentile":62.95,"90th_percentile":223.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"1 through 10","median_amount":381.89,"10th_percentile":381.89,"90th_percentile":381.89},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1175","median_amount":114.31,"10th_percentile":73.56,"90th_percentile":687.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"107","median_amount":255.35,"10th_percentile":73.08,"90th_percentile":706.17},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"21","median_amount":89.18,"10th_percentile":59.95,"90th_percentile":320.74},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"64","median_amount":157.26,"10th_percentile":77.69,"90th_percentile":223.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"135","median_amount":72.17,"10th_percentile":63.08,"90th_percentile":186.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":87.75,"10th_percentile":87.75,"90th_percentile":87.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"876","median_amount":72.17,"10th_percentile":59.95,"90th_percentile":204.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"101","median_amount":229.75,"10th_percentile":78.33,"90th_percentile":1129.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.3,"10th_percentile":61.3,"90th_percentile":61.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":166.07,"10th_percentile":166.07,"90th_percentile":166.07},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"83","median_amount":72.17,"10th_percentile":54.07,"90th_percentile":181.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"175","median_amount":260.3,"10th_percentile":103.92,"90th_percentile":1359.15},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":88.9,"10th_percentile":47.31,"90th_percentile":234.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"236","median_amount":143.09,"10th_percentile":85.57,"90th_percentile":818.63},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":630.7,"10th_percentile":100.95,"90th_percentile":718.0},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":88.06,"10th_percentile":39.06,"90th_percentile":161.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":157.26,"10th_percentile":157.26,"90th_percentile":157.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"212","median_amount":72.17,"10th_percentile":62.95,"90th_percentile":181.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":69.6,"10th_percentile":69.6,"90th_percentile":69.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"20","median_amount":127.06,"10th_percentile":102.39,"90th_percentile":397.8},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":126.99,"10th_percentile":124.19,"90th_percentile":256.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"81","median_amount":185.0,"10th_percentile":125.95,"90th_percentile":462.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1309","median_amount":124.19,"10th_percentile":70.69,"90th_percentile":949.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"115","median_amount":72.17,"10th_percentile":61.75,"90th_percentile":231.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"216","median_amount":88.07,"10th_percentile":59.95,"90th_percentile":177.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"76","median_amount":966.64,"10th_percentile":127.31,"90th_percentile":1506.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"356","median_amount":107.25,"10th_percentile":99.99,"90th_percentile":207.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"1 through 10","median_amount":186.58,"10th_percentile":186.58,"90th_percentile":186.58},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"568","median_amount":701.38,"10th_percentile":82.69,"90th_percentile":1103.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"54","median_amount":436.8,"10th_percentile":72.98,"90th_percentile":771.23},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"12","median_amount":445.54,"10th_percentile":136.44,"90th_percentile":836.16},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"37","median_amount":189.93,"10th_percentile":121.54,"90th_percentile":394.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"56","median_amount":886.71,"10th_percentile":99.07,"90th_percentile":1592.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":106.36,"10th_percentile":106.36,"90th_percentile":106.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1014.52,"10th_percentile":1014.52,"90th_percentile":1014.52},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"57","median_amount":124.18,"10th_percentile":72.17,"90th_percentile":233.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"126","median_amount":1139.0,"10th_percentile":125.31,"90th_percentile":1503.65},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":107.36,"10th_percentile":105.25,"90th_percentile":209.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"119","median_amount":858.9,"10th_percentile":402.14,"90th_percentile":1238.3},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":197.28,"10th_percentile":197.28,"90th_percentile":197.28},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":106.85,"10th_percentile":57.35,"90th_percentile":120.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":109.34,"10th_percentile":109.34,"90th_percentile":369.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"101","median_amount":124.18,"10th_percentile":69.0,"90th_percentile":233.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":85.08,"10th_percentile":84.2,"90th_percentile":520.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":871.0,"10th_percentile":464.1,"90th_percentile":1445.6},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":352.72,"10th_percentile":352.72,"90th_percentile":352.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"11","median_amount":309.31,"10th_percentile":178.59,"90th_percentile":309.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"28","median_amount":309.31,"10th_percentile":186.25,"90th_percentile":309.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":257.19,"10th_percentile":257.19,"90th_percentile":257.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"719","median_amount":1075.5,"10th_percentile":91.08,"90th_percentile":1592.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"59","median_amount":124.18,"10th_percentile":72.17,"90th_percentile":295.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"219","median_amount":106.36,"10th_percentile":65.48,"90th_percentile":207.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"31","median_amount":1820.62,"10th_percentile":640.62,"90th_percentile":2095.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"124","median_amount":241.75,"10th_percentile":140.15,"90th_percentile":245.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"225","median_amount":1423.62,"10th_percentile":520.19,"90th_percentile":1840.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"23","median_amount":324.7,"10th_percentile":324.7,"90th_percentile":432.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"95","median_amount":240.0,"10th_percentile":112.0,"90th_percentile":391.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"26","median_amount":977.49,"10th_percentile":381.97,"90th_percentile":1059.24},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":1381.35,"10th_percentile":897.72,"90th_percentile":1840.18},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"13","median_amount":431.71,"10th_percentile":323.78,"90th_percentile":964.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"22","median_amount":324.7,"10th_percentile":310.42,"90th_percentile":324.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"149","median_amount":324.7,"10th_percentile":310.42,"90th_percentile":505.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"25","median_amount":1921.5,"10th_percentile":1013.5,"90th_percentile":2095.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":194.26,"10th_percentile":194.26,"90th_percentile":194.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"17","median_amount":324.7,"10th_percentile":324.7,"90th_percentile":500.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"106","median_amount":1978.8,"10th_percentile":1433.95,"90th_percentile":3254.65},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":241.96,"10th_percentile":74.68,"90th_percentile":281.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"40","median_amount":1629.6,"10th_percentile":1093.58,"90th_percentile":2064.3},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":243.46,"10th_percentile":240.35,"90th_percentile":328.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":431.71,"10th_percentile":431.71,"90th_percentile":431.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"43","median_amount":324.7,"10th_percentile":310.42,"90th_percentile":500.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":193.4,"10th_percentile":193.4,"90th_percentile":193.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1513.2,"10th_percentile":1513.2,"90th_percentile":2947.1},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":682.2,"10th_percentile":682.2,"90th_percentile":682.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"19","median_amount":703.07,"10th_percentile":703.07,"90th_percentile":1527.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"325","median_amount":1921.5,"10th_percentile":945.7,"90th_percentile":3074.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"21","median_amount":324.7,"10th_percentile":310.42,"90th_percentile":500.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"108","median_amount":223.64,"10th_percentile":114.36,"90th_percentile":402.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":1938.44,"10th_percentile":1903.17,"90th_percentile":3102.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"96","median_amount":548.84,"10th_percentile":528.56,"90th_percentile":763.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"15","median_amount":449.09,"10th_percentile":449.09,"90th_percentile":587.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"78","median_amount":1279.2,"10th_percentile":594.94,"90th_percentile":2242.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":879.81,"10th_percentile":699.56,"90th_percentile":1634.82},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":979.25,"10th_percentile":783.4,"90th_percentile":979.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":449.09,"10th_percentile":449.09,"90th_percentile":449.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":422.5,"10th_percentile":422.5,"90th_percentile":422.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1734.3,"10th_percentile":1677.6,"90th_percentile":1782.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2050.0,"10th_percentile":2050.0,"90th_percentile":2050.0},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"26","median_amount":1742.5,"10th_percentile":1584.4,"90th_percentile":3151.8},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":548.58,"10th_percentile":538.58,"90th_percentile":558.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"15","median_amount":1435.0,"10th_percentile":1323.44,"90th_percentile":4064.7},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":549.38,"10th_percentile":549.38,"90th_percentile":549.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":979.25,"10th_percentile":979.25,"90th_percentile":979.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"13","median_amount":449.09,"10th_percentile":429.35,"90th_percentile":1135.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1332.5,"10th_percentile":1332.5,"90th_percentile":1332.5},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":7451.16,"10th_percentile":1594.77,"90th_percentile":7739.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"87","median_amount":1845.0,"10th_percentile":1159.33,"90th_percentile":3233.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":449.09,"10th_percentile":449.09,"90th_percentile":2614.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"53","median_amount":438.71,"10th_percentile":420.98,"90th_percentile":612.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":2723.46,"10th_percentile":1580.88,"90th_percentile":5669.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"31","median_amount":181.68,"10th_percentile":170.92,"90th_percentile":879.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"49","median_amount":1400.11,"10th_percentile":540.82,"90th_percentile":2757.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1433.46,"10th_percentile":832.51,"90th_percentile":2986.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":1820.86,"10th_percentile":1820.86,"90th_percentile":1820.86},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":317.94,"10th_percentile":317.94,"90th_percentile":1485.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"15","median_amount":518.72,"10th_percentile":72.17,"90th_percentile":1165.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"64","median_amount":500.42,"10th_percentile":181.26,"90th_percentile":987.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3296.55,"10th_percentile":3296.55,"90th_percentile":11740.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"11","median_amount":2217.66,"10th_percentile":818.55,"90th_percentile":3405.11},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":181.24,"10th_percentile":178.51,"90th_percentile":1168.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2356.49,"10th_percentile":551.88,"90th_percentile":4689.26},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1136.45,"10th_percentile":181.68,"90th_percentile":1383.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"14","median_amount":528.78,"10th_percentile":500.42,"90th_percentile":1101.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2529.8,"10th_percentile":2529.8,"90th_percentile":2529.8},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":590.46,"10th_percentile":590.46,"90th_percentile":590.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":517.79,"10th_percentile":517.79,"90th_percentile":960.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"83","median_amount":2488.14,"10th_percentile":866.7,"90th_percentile":5372.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":253.43,"10th_percentile":253.43,"90th_percentile":253.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"47","median_amount":209.66,"10th_percentile":142.43,"90th_percentile":1157.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"22","median_amount":4138.06,"10th_percentile":2105.89,"90th_percentile":5039.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"60","median_amount":361.18,"10th_percentile":337.96,"90th_percentile":893.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"145","median_amount":2513.48,"10th_percentile":742.35,"90th_percentile":3882.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"16","median_amount":500.42,"10th_percentile":490.68,"90th_percentile":1153.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":364.47,"10th_percentile":177.06,"90th_percentile":774.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"13","median_amount":1901.22,"10th_percentile":1099.64,"90th_percentile":2636.13},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":3673.81,"10th_percentile":3673.81,"90th_percentile":3673.81},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"14","median_amount":637.82,"10th_percentile":478.36,"90th_percentile":1526.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"23","median_amount":600.52,"10th_percentile":490.68,"90th_percentile":1176.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"99","median_amount":627.93,"10th_percentile":490.68,"90th_percentile":1211.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"13","median_amount":3698.42,"10th_percentile":2914.62,"90th_percentile":5720.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"14","median_amount":557.32,"10th_percentile":490.68,"90th_percentile":734.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"42","median_amount":4173.5,"10th_percentile":3030.26,"90th_percentile":6746.84},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":361.68,"10th_percentile":236.68,"90th_percentile":939.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"25","median_amount":3107.31,"10th_percentile":2457.21,"90th_percentile":4083.11},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":856.65,"10th_percentile":856.65,"90th_percentile":856.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":3655.07,"10th_percentile":3655.07,"90th_percentile":3655.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"34","median_amount":500.42,"10th_percentile":490.68,"90th_percentile":1230.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2200.0,"10th_percentile":2200.0,"90th_percentile":2200.0},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":665.28,"10th_percentile":665.28,"90th_percentile":665.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1070.66,"10th_percentile":1070.66,"90th_percentile":1070.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1864.98,"10th_percentile":1038.74,"90th_percentile":2191.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"187","median_amount":3900.78,"10th_percentile":2368.99,"90th_percentile":5699.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"13","median_amount":593.95,"10th_percentile":490.68,"90th_percentile":1230.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"39","median_amount":357.19,"10th_percentile":262.29,"90th_percentile":857.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":3035.82,"10th_percentile":3035.82,"90th_percentile":3035.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":790.67,"10th_percentile":790.67,"90th_percentile":790.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1533.03,"10th_percentile":1533.03,"90th_percentile":1533.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"11","median_amount":2263.4,"10th_percentile":1782.16,"90th_percentile":2829.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":108.53,"10th_percentile":108.53,"90th_percentile":108.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1862.6,"10th_percentile":1862.6,"90th_percentile":1862.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":1539.73,"10th_percentile":1539.73,"90th_percentile":1539.73},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":738.1,"10th_percentile":738.1,"90th_percentile":738.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3227.41,"10th_percentile":3227.41,"90th_percentile":3227.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":3321.82,"10th_percentile":3321.82,"90th_percentile":3321.82},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":790.37,"10th_percentile":790.37,"90th_percentile":790.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":4093.61,"10th_percentile":4093.61,"90th_percentile":4093.61},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2574.45,"10th_percentile":1736.88,"90th_percentile":4189.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":557.22,"10th_percentile":557.22,"90th_percentile":557.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":632.14,"10th_percentile":632.14,"90th_percentile":632.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":1569.33,"10th_percentile":1480.58,"90th_percentile":1922.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":402.22,"10th_percentile":321.51,"90th_percentile":405.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":378.3,"10th_percentile":378.3,"90th_percentile":378.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"18","median_amount":1260.48,"10th_percentile":950.32,"90th_percentile":1388.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":395.7,"10th_percentile":395.7,"90th_percentile":395.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":398.73,"10th_percentile":98.09,"90th_percentile":409.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":919.1,"10th_percentile":919.1,"90th_percentile":919.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":378.3,"10th_percentile":378.3,"90th_percentile":378.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"18","median_amount":395.7,"10th_percentile":395.7,"90th_percentile":550.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1818.0,"10th_percentile":1818.0,"90th_percentile":1818.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1762.05,"10th_percentile":1762.05,"90th_percentile":1762.05},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1575.0,"10th_percentile":1400.31,"90th_percentile":2595.81},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":402.89,"10th_percentile":402.89,"90th_percentile":402.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":395.7,"10th_percentile":395.7,"90th_percentile":395.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1482.65,"10th_percentile":1482.65,"90th_percentile":1482.65},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1168.76,"10th_percentile":1168.76,"90th_percentile":1168.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"26","median_amount":1965.22,"10th_percentile":1492.56,"90th_percentile":2255.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":303.89,"10th_percentile":303.89,"90th_percentile":407.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":2972.16,"10th_percentile":2972.16,"90th_percentile":2972.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":1743.2,"10th_percentile":1743.2,"90th_percentile":1905.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":396.54,"10th_percentile":396.54,"90th_percentile":396.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1270.36,"10th_percentile":1270.36,"90th_percentile":1270.36},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2474.35,"10th_percentile":2474.35,"90th_percentile":2474.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":538.36,"10th_percentile":538.36,"90th_percentile":538.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":8162.98,"10th_percentile":4924.42,"90th_percentile":10236.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"35","median_amount":1309.66,"10th_percentile":1109.66,"90th_percentile":2433.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1267.43,"10th_percentile":1267.43,"90th_percentile":1267.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"39","median_amount":5732.69,"10th_percentile":4317.19,"90th_percentile":9780.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1491.97,"10th_percentile":1491.97,"90th_percentile":1491.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":1311.87,"10th_percentile":1009.39,"90th_percentile":1869.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":4238.99,"10th_percentile":3960.7,"90th_percentile":5490.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":2331.56,"10th_percentile":2331.56,"90th_percentile":2331.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1267.43,"10th_percentile":1267.43,"90th_percentile":1267.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"17","median_amount":1267.43,"10th_percentile":1267.43,"90th_percentile":1491.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":8268.3,"10th_percentile":8268.3,"90th_percentile":29653.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2474.82,"10th_percentile":1491.97,"90th_percentile":3269.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":8325.75,"10th_percentile":8232.25,"90th_percentile":10068.25},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1310.43,"10th_percentile":1072.48,"90th_percentile":1858.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":6779.5,"10th_percentile":6708.02,"90th_percentile":15545.15},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1311.57,"10th_percentile":1311.57,"90th_percentile":1311.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2427.41,"10th_percentile":2427.41,"90th_percentile":2427.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1228.79,"10th_percentile":1228.79,"90th_percentile":1310.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":5860.06,"10th_percentile":5860.06,"90th_percentile":5860.06},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1520.62,"10th_percentile":1520.62,"90th_percentile":1520.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":5391.88,"10th_percentile":5391.88,"90th_percentile":5391.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"43","median_amount":8670.23,"10th_percentile":6680.6,"90th_percentile":9621.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1267.43,"10th_percentile":1267.43,"90th_percentile":1267.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"24","median_amount":1305.68,"10th_percentile":1044.54,"90th_percentile":1854.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":69.56,"10th_percentile":40.35,"90th_percentile":498.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":53.43,"10th_percentile":47.52,"90th_percentile":53.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":90.26,"10th_percentile":90.26,"90th_percentile":109.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"1 through 10","median_amount":270.07,"10th_percentile":270.07,"90th_percentile":270.07},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"55","median_amount":361.92,"10th_percentile":275.36,"90th_percentile":17937.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":47.52,"10th_percentile":47.52,"90th_percentile":991.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":49.89,"10th_percentile":49.89,"90th_percentile":85.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":251.1,"10th_percentile":188.8,"90th_percentile":801.28},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":71.56,"10th_percentile":71.56,"90th_percentile":71.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":45.43,"10th_percentile":45.43,"90th_percentile":57.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"28","median_amount":47.52,"10th_percentile":47.52,"90th_percentile":1823.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":835.2,"10th_percentile":580.0,"90th_percentile":38812.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":52.32,"10th_percentile":46.93,"90th_percentile":1131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"18","median_amount":493.0,"10th_percentile":100.0,"90th_percentile":20508.66},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.09,"10th_percentile":50.09,"90th_percentile":50.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":28273.74,"10th_percentile":456.82,"90th_percentile":44849.21},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":53.43,"10th_percentile":53.43,"90th_percentile":53.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":54.75,"10th_percentile":52.32,"90th_percentile":494.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":248.3,"10th_percentile":248.3,"90th_percentile":248.3},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":165.46,"10th_percentile":165.46,"90th_percentile":165.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":145.09,"10th_percentile":145.09,"90th_percentile":145.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"55","median_amount":34.78,"10th_percentile":21.47,"90th_percentile":643.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":47.52,"10th_percentile":47.52,"90th_percentile":47.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.91,"10th_percentile":49.89,"90th_percentile":750.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":175.34,"10th_percentile":175.34,"90th_percentile":175.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":171.38,"10th_percentile":171.38,"90th_percentile":171.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":370.83,"10th_percentile":370.83,"90th_percentile":370.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"13","median_amount":805.59,"10th_percentile":560.67,"90th_percentile":1706.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":134.58,"10th_percentile":134.58,"90th_percentile":134.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":152.67,"10th_percentile":152.67,"90th_percentile":160.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":590.71,"10th_percentile":590.71,"90th_percentile":590.71},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":306.06,"10th_percentile":306.06,"90th_percentile":306.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":134.58,"10th_percentile":134.58,"90th_percentile":134.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":134.58,"10th_percentile":134.58,"90th_percentile":134.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":2184.5,"10th_percentile":2184.5,"90th_percentile":2184.5},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":418.82,"10th_percentile":320.44,"90th_percentile":599.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"13","median_amount":124.07,"10th_percentile":110.0,"90th_percentile":302.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.03,"10th_percentile":160.03,"90th_percentile":160.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":25945.43,"10th_percentile":25945.43,"90th_percentile":27259.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":840.0,"10th_percentile":840.0,"90th_percentile":840.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":17497.85,"10th_percentile":784.4,"90th_percentile":46748.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":359.77,"10th_percentile":359.77,"90th_percentile":359.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":2653.87,"10th_percentile":2653.87,"90th_percentile":2653.87},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":232.02,"10th_percentile":232.02,"90th_percentile":232.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":192.28,"10th_percentile":186.46,"90th_percentile":1717.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":371.51,"10th_percentile":371.51,"90th_percentile":34921.56},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5037.53,"10th_percentile":5037.53,"90th_percentile":5037.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":393.0,"10th_percentile":393.0,"90th_percentile":393.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":738.9,"10th_percentile":504.09,"90th_percentile":60205.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":823.02,"10th_percentile":823.02,"90th_percentile":823.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":67005.57,"10th_percentile":67005.57,"90th_percentile":67005.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":2626.55,"10th_percentile":1281.17,"90th_percentile":13554.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1412.18,"10th_percentile":1412.18,"90th_percentile":1412.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":5549.23,"10th_percentile":239.61,"90th_percentile":44718.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1427.32,"10th_percentile":1427.32,"90th_percentile":1427.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":2540.32,"10th_percentile":1678.82,"90th_percentile":2699.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":14341.77,"10th_percentile":14341.77,"90th_percentile":14341.77},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":3783.02,"10th_percentile":3783.02,"90th_percentile":3783.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"14","median_amount":2113.68,"10th_percentile":824.87,"90th_percentile":2411.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":86504.11,"10th_percentile":86504.11,"90th_percentile":86504.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2670.44,"10th_percentile":2670.44,"90th_percentile":2670.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":7340.54,"10th_percentile":7340.54,"90th_percentile":7340.54},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"14","median_amount":15055.61,"10th_percentile":6886.7,"90th_percentile":83920.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3320.42,"10th_percentile":3320.42,"90th_percentile":3320.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2531.25,"10th_percentile":2525.62,"90th_percentile":2562.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":446.55,"10th_percentile":121.06,"90th_percentile":1344.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"23","median_amount":246.71,"10th_percentile":160.58,"90th_percentile":1697.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":103.94,"10th_percentile":102.7,"90th_percentile":103.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"78","median_amount":148.68,"10th_percentile":101.02,"90th_percentile":388.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":168.74,"10th_percentile":134.03,"90th_percentile":1018.97},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":170.13,"10th_percentile":170.13,"90th_percentile":170.13},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"12","median_amount":159.54,"10th_percentile":107.8,"90th_percentile":234.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":169.87,"10th_percentile":169.87,"90th_percentile":169.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"43","median_amount":139.16,"10th_percentile":98.97,"90th_percentile":189.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":231.49,"10th_percentile":121.63,"90th_percentile":443.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":173.75,"10th_percentile":173.75,"90th_percentile":173.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"34","median_amount":13676.34,"10th_percentile":151.69,"90th_percentile":14174.07},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":143.98,"10th_percentile":143.98,"90th_percentile":143.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"19","median_amount":197.99,"10th_percentile":176.99,"90th_percentile":265.68},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":108.04,"10th_percentile":108.04,"90th_percentile":108.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"19","median_amount":103.94,"10th_percentile":103.16,"90th_percentile":188.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":306.1,"10th_percentile":306.1,"90th_percentile":306.1},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":228.27,"10th_percentile":228.27,"90th_percentile":228.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":170.97,"10th_percentile":170.97,"90th_percentile":170.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"98","median_amount":162.76,"10th_percentile":81.22,"90th_percentile":1006.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1394.49,"10th_percentile":113.18,"90th_percentile":1698.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"16","median_amount":2552.82,"10th_percentile":1177.2,"90th_percentile":3240.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"32","median_amount":866.64,"10th_percentile":506.47,"90th_percentile":2649.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":496.94,"10th_percentile":496.94,"90th_percentile":1195.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"92","median_amount":593.83,"10th_percentile":55.56,"90th_percentile":2580.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":730.46,"10th_percentile":496.94,"90th_percentile":16547.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":943.95,"10th_percentile":256.87,"90th_percentile":1376.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":26764.55,"10th_percentile":26764.55,"90th_percentile":26764.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1158.61,"10th_percentile":934.1,"90th_percentile":1238.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"32","median_amount":606.86,"10th_percentile":462.7,"90th_percentile":1031.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"120","median_amount":624.6,"10th_percentile":278.66,"90th_percentile":1123.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1267.17,"10th_percentile":1082.33,"90th_percentile":3562.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"41","median_amount":352.78,"10th_percentile":352.78,"90th_percentile":666.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"63","median_amount":635.8,"10th_percentile":464.95,"90th_percentile":2681.1},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":914.17,"10th_percentile":914.17,"90th_percentile":914.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"25","median_amount":1518.42,"10th_percentile":580.16,"90th_percentile":4124.78},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3594.4,"10th_percentile":3594.4,"90th_percentile":3594.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":397.49,"10th_percentile":397.49,"90th_percentile":397.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"50","median_amount":352.78,"10th_percentile":219.85,"90th_percentile":1173.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1332.9,"10th_percentile":1332.9,"90th_percentile":1332.9},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1073.4,"10th_percentile":797.17,"90th_percentile":5354.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"102","median_amount":1594.22,"10th_percentile":597.8,"90th_percentile":5877.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":623.56,"10th_percentile":488.22,"90th_percentile":776.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"68","median_amount":356.29,"10th_percentile":256.87,"90th_percentile":1181.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":15752.65,"10th_percentile":15752.65,"90th_percentile":15752.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":7649.9,"10th_percentile":7649.9,"90th_percentile":9568.65},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":458.65,"10th_percentile":456.04,"90th_percentile":961.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":159.68,"10th_percentile":150.22,"90th_percentile":160.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":429.98,"10th_percentile":405.45,"90th_percentile":479.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":379.03,"10th_percentile":379.03,"90th_percentile":379.03},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":267.03,"10th_percentile":267.03,"90th_percentile":267.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":82.58,"10th_percentile":82.58,"90th_percentile":82.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"19","median_amount":123.88,"10th_percentile":82.58,"90th_percentile":186.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1006.2,"10th_percentile":1006.2,"90th_percentile":1006.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":950.3,"10th_percentile":391.0,"90th_percentile":950.3},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":156.69,"10th_percentile":156.69,"90th_percentile":156.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":626.08,"10th_percentile":296.78,"90th_percentile":782.6},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.99,"10th_percentile":119.99,"90th_percentile":119.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":279.44,"10th_percentile":279.44,"90th_percentile":279.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":100.88,"10th_percentile":100.88,"90th_percentile":137.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":726.7,"10th_percentile":726.7,"90th_percentile":726.7},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":455.09,"10th_percentile":455.09,"90th_percentile":455.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"48","median_amount":914.4,"10th_percentile":397.35,"90th_percentile":1006.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":82.58,"10th_percentile":82.58,"90th_percentile":82.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":157.49,"10th_percentile":156.49,"90th_percentile":228.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":1326.98,"10th_percentile":1009.64,"90th_percentile":1326.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"26","median_amount":311.44,"10th_percentile":249.16,"90th_percentile":376.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":297.32,"10th_percentile":268.15,"90th_percentile":396.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"27","median_amount":907.75,"10th_percentile":586.05,"90th_percentile":1511.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":297.32,"10th_percentile":297.32,"90th_percentile":333.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":311.44,"10th_percentile":249.16,"90th_percentile":313.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":480.75,"10th_percentile":137.96,"90th_percentile":1091.78},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":551.15,"10th_percentile":476.57,"90th_percentile":1112.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":137.96,"10th_percentile":137.96,"90th_percentile":256.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"41","median_amount":268.15,"10th_percentile":137.96,"90th_percentile":337.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1056.6,"10th_percentile":400.0,"90th_percentile":1744.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":337.34,"10th_percentile":268.15,"90th_percentile":366.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1311.55,"10th_percentile":827.84,"90th_percentile":1840.96},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":311.64,"10th_percentile":311.64,"90th_percentile":408.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":756.86,"10th_percentile":599.78,"90th_percentile":1099.0},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":311.84,"10th_percentile":311.84,"90th_percentile":311.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":297.32,"10th_percentile":268.15,"90th_percentile":983.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1021.04,"10th_percentile":1021.04,"90th_percentile":1021.04},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":905.73,"10th_percentile":873.84,"90th_percentile":905.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"56","median_amount":1262.7,"10th_percentile":624.39,"90th_percentile":1818.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":337.34,"10th_percentile":297.32,"90th_percentile":347.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"23","median_amount":262.45,"10th_percentile":146.55,"90th_percentile":352.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":1482.24,"10th_percentile":1482.24,"90th_percentile":1482.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":939.76,"10th_percentile":939.76,"90th_percentile":939.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":1702.9,"10th_percentile":1702.9,"90th_percentile":1702.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":861.77,"10th_percentile":861.77,"90th_percentile":861.77},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":137.96,"10th_percentile":137.96,"90th_percentile":137.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":856.13,"10th_percentile":137.96,"90th_percentile":939.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1704.6,"10th_percentile":1704.6,"90th_percentile":1704.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":7080.5,"10th_percentile":7080.5,"90th_percentile":7080.5},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":5161.8,"10th_percentile":5161.8,"90th_percentile":5161.8},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1704.6,"10th_percentile":1534.14,"90th_percentile":1704.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":530.67,"10th_percentile":530.67,"90th_percentile":530.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":5932.28,"10th_percentile":5649.34,"90th_percentile":6525.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":1014.21,"10th_percentile":1001.4,"90th_percentile":1021.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":895.5,"10th_percentile":895.5,"90th_percentile":895.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"18","median_amount":3729.56,"10th_percentile":1919.84,"90th_percentile":4099.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":895.5,"10th_percentile":895.5,"90th_percentile":895.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":814.03,"10th_percentile":814.03,"90th_percentile":1058.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":2441.9,"10th_percentile":2441.9,"90th_percentile":2441.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1817.03,"10th_percentile":1817.03,"90th_percentile":1817.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":895.5,"10th_percentile":895.5,"90th_percentile":895.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"40","median_amount":895.5,"10th_percentile":895.5,"90th_percentile":895.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6208.2,"10th_percentile":6208.2,"90th_percentile":6829.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":895.5,"10th_percentile":895.5,"90th_percentile":895.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"16","median_amount":5583.65,"10th_percentile":5583.65,"90th_percentile":6449.8},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"16","median_amount":4598.3,"10th_percentile":4420.09,"90th_percentile":5311.6},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"13","median_amount":895.5,"10th_percentile":856.13,"90th_percentile":895.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":814.03,"10th_percentile":814.03,"90th_percentile":814.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":4932.2,"10th_percentile":4932.2,"90th_percentile":4932.2},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":3374.48,"10th_percentile":3374.48,"90th_percentile":3374.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":2959.16,"10th_percentile":2959.16,"90th_percentile":2959.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"54","median_amount":5912.1,"10th_percentile":3989.23,"90th_percentile":6829.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":895.5,"10th_percentile":895.5,"90th_percentile":895.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"14","median_amount":814.03,"10th_percentile":814.03,"90th_percentile":1018.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":24.52,"10th_percentile":23.52,"90th_percentile":27.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":60.17,"10th_percentile":60.17,"90th_percentile":60.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":117.4,"10th_percentile":117.4,"90th_percentile":117.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":66.31,"10th_percentile":66.31,"90th_percentile":66.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":70.59,"10th_percentile":70.59,"90th_percentile":70.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":232.2,"10th_percentile":232.2,"90th_percentile":232.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":14.54,"10th_percentile":14.54,"90th_percentile":42083.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":501.6,"10th_percentile":501.6,"90th_percentile":942.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":751.64,"10th_percentile":751.64,"90th_percentile":751.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":460.65,"10th_percentile":460.65,"90th_percentile":460.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":47.52,"10th_percentile":47.52,"90th_percentile":47.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"15","median_amount":168.97,"10th_percentile":104.1,"90th_percentile":1911.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"35","median_amount":60.62,"10th_percentile":57.04,"90th_percentile":108.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"1 through 10","median_amount":47.53,"10th_percentile":47.53,"90th_percentile":47.53},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"127","median_amount":143.59,"10th_percentile":40.39,"90th_percentile":485.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"17","median_amount":90.15,"10th_percentile":84.45,"90th_percentile":445.91},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":70.08,"10th_percentile":70.08,"90th_percentile":70.08},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":129.52,"10th_percentile":129.52,"90th_percentile":129.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"15","median_amount":54.76,"10th_percentile":29.88,"90th_percentile":96.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"77","median_amount":58.94,"10th_percentile":29.88,"90th_percentile":117.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":275.4,"10th_percentile":138.45,"90th_percentile":700.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":111.77,"10th_percentile":29.88,"90th_percentile":138.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"19","median_amount":410.81,"10th_percentile":260.1,"90th_percentile":1008.8},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":59.61,"10th_percentile":59.61,"90th_percentile":449.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"19","median_amount":81.63,"10th_percentile":19.93,"90th_percentile":375.9},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":38.32,"10th_percentile":38.32,"90th_percentile":38.32},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":76.64,"10th_percentile":73.53,"90th_percentile":90.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"26","median_amount":54.76,"10th_percentile":29.88,"90th_percentile":149.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":43.52,"10th_percentile":43.52,"90th_percentile":43.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":197.02,"10th_percentile":197.02,"90th_percentile":197.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"13","median_amount":172.77,"10th_percentile":157.9,"90th_percentile":172.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":59.41,"10th_percentile":59.41,"90th_percentile":59.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"139","median_amount":250.2,"10th_percentile":65.0,"90th_percentile":916.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"13","median_amount":53.72,"10th_percentile":29.88,"90th_percentile":152.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"25","median_amount":60.31,"10th_percentile":15.31,"90th_percentile":103.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"12","median_amount":581.36,"10th_percentile":253.48,"90th_percentile":1201.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"15","median_amount":128.92,"10th_percentile":123.76,"90th_percentile":131.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":244.53,"10th_percentile":165.18,"90th_percentile":311.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"92","median_amount":448.97,"10th_percentile":193.54,"90th_percentile":1049.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":152.3,"10th_percentile":122.96,"90th_percentile":289.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":103.14,"10th_percentile":97.82,"90th_percentile":130.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":178.82,"10th_percentile":110.11,"90th_percentile":358.09},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":403.1,"10th_percentile":403.1,"90th_percentile":403.1},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":230.21,"10th_percentile":230.21,"90th_percentile":245.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"12","median_amount":165.18,"10th_percentile":152.3,"90th_percentile":265.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"54","median_amount":157.92,"10th_percentile":97.64,"90th_percentile":245.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1182.6,"10th_percentile":819.94,"90th_percentile":20343.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"12","median_amount":148.94,"10th_percentile":116.12,"90th_percentile":315.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"31","median_amount":574.6,"10th_percentile":210.8,"90th_percentile":1378.57},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":129.12,"10th_percentile":129.12,"90th_percentile":129.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"15","median_amount":765.8,"10th_percentile":275.1,"90th_percentile":1025.44},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":123.28,"10th_percentile":123.28,"90th_percentile":123.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":245.99,"10th_percentile":245.99,"90th_percentile":245.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"21","median_amount":152.3,"10th_percentile":112.92,"90th_percentile":265.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":768.69,"10th_percentile":768.69,"90th_percentile":768.69},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":163.0,"10th_percentile":163.0,"90th_percentile":163.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":250.0,"10th_percentile":163.0,"90th_percentile":620.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"94","median_amount":608.4,"10th_percentile":296.1,"90th_percentile":3195.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":256.06,"10th_percentile":152.3,"90th_percentile":584.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":124.78,"10th_percentile":79.92,"90th_percentile":131.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":295.55,"10th_percentile":295.55,"90th_percentile":295.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"90","median_amount":36.13,"10th_percentile":34.66,"90th_percentile":38.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"16","median_amount":134.79,"10th_percentile":126.81,"90th_percentile":245.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":136.08,"10th_percentile":136.08,"90th_percentile":136.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":85.35,"10th_percentile":85.35,"90th_percentile":85.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"13","median_amount":29.03,"10th_percentile":29.03,"90th_percentile":43.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":29.03,"10th_percentile":29.03,"90th_percentile":29.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":323.85,"10th_percentile":183.6,"90th_percentile":323.85},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":37.5,"10th_percentile":36.3,"90th_percentile":37.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":96.72,"10th_percentile":96.72,"90th_percentile":96.72},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38.06,"10th_percentile":38.06,"90th_percentile":53.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":64.47,"10th_percentile":64.47,"90th_percentile":64.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":40.87,"10th_percentile":40.87,"90th_percentile":40.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"18","median_amount":196.2,"10th_percentile":156.96,"90th_percentile":342.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":29.03,"10th_percentile":29.03,"90th_percentile":29.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"29","median_amount":29.84,"10th_percentile":28.88,"90th_percentile":38.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":5716.42,"10th_percentile":5716.42,"90th_percentile":5716.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"14","median_amount":2272.14,"10th_percentile":916.3,"90th_percentile":4432.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":2243.76,"10th_percentile":1624.14,"90th_percentile":6131.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2898.67,"10th_percentile":125.93,"90th_percentile":4452.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":3233.74,"10th_percentile":3233.74,"90th_percentile":3233.74},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1349.28,"10th_percentile":1349.28,"90th_percentile":1349.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":87.9,"10th_percentile":87.9,"90th_percentile":87.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":439.5,"10th_percentile":168.06,"90th_percentile":1098.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":780.3,"10th_percentile":780.3,"90th_percentile":780.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":2702.15,"10th_percentile":2702.15,"90th_percentile":2702.15},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4174.5,"10th_percentile":3400.11,"90th_percentile":4582.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1780.24,"10th_percentile":809.2,"90th_percentile":7282.8},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":4624.0,"10th_percentile":4624.0,"90th_percentile":4624.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"18","median_amount":5982.3,"10th_percentile":520.2,"90th_percentile":9363.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":395.55,"10th_percentile":395.55,"90th_percentile":395.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2266.74,"10th_percentile":2124.99,"90th_percentile":4659.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":654.97,"10th_percentile":624.95,"90th_percentile":655.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":2267.74,"10th_percentile":2267.74,"90th_percentile":2267.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":483.05,"10th_percentile":483.05,"90th_percentile":483.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":660.67,"10th_percentile":660.67,"90th_percentile":662.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":577.09,"10th_percentile":577.09,"90th_percentile":577.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":3178.63,"10th_percentile":3178.63,"90th_percentile":3314.67},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":654.67,"10th_percentile":654.67,"90th_percentile":654.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":660.97,"10th_percentile":660.97,"90th_percentile":660.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":661.98,"10th_percentile":654.48,"90th_percentile":1161.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":278.93,"10th_percentile":278.93,"90th_percentile":278.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":176.78,"10th_percentile":176.78,"90th_percentile":280.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":902.92,"10th_percentile":654.65,"90th_percentile":1411.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":314.81,"10th_percentile":314.81,"90th_percentile":314.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":414.72,"10th_percentile":414.72,"90th_percentile":414.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1153.11,"10th_percentile":1153.11,"90th_percentile":11358.21},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":855.73,"10th_percentile":855.73,"90th_percentile":855.73},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":244.6,"10th_percentile":244.6,"90th_percentile":244.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":206.68,"10th_percentile":176.78,"90th_percentile":213.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"14","median_amount":176.78,"10th_percentile":114.32,"90th_percentile":248.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":186.53,"10th_percentile":186.53,"90th_percentile":186.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":37462.53,"10th_percentile":37462.53,"90th_percentile":37462.53},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":176.78,"10th_percentile":176.78,"90th_percentile":245.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1282.37,"10th_percentile":176.78,"90th_percentile":1476.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":186.53,"10th_percentile":186.53,"90th_percentile":314.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2543.99,"10th_percentile":2543.99,"90th_percentile":2543.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Health and Behavior Services","code_information":[{"code":"5822","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":215.9,"10th_percentile":215.9,"90th_percentile":215.9},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":174.75,"10th_percentile":174.75,"90th_percentile":174.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"27","median_amount":161.19,"10th_percentile":153.13,"90th_percentile":161.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"18","median_amount":92.27,"10th_percentile":82.76,"90th_percentile":218.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":165.1,"10th_percentile":165.1,"90th_percentile":165.1},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"11","median_amount":228.6,"10th_percentile":62.1,"90th_percentile":254.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rabies vaccine, im","code_information":[{"code":"9139","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":4703.6,"10th_percentile":4703.6,"90th_percentile":4703.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":1003.41,"10th_percentile":1003.41,"90th_percentile":1003.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":4649.01,"10th_percentile":4649.01,"90th_percentile":4649.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1016.97,"10th_percentile":1016.97,"90th_percentile":1016.97},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1773.92,"10th_percentile":1773.92,"90th_percentile":1773.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":129.39,"10th_percentile":129.39,"90th_percentile":129.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":129.39,"10th_percentile":129.39,"90th_percentile":129.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":7040.67,"10th_percentile":7040.67,"90th_percentile":7040.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":8301.65,"10th_percentile":8301.65,"90th_percentile":8301.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12001.12,"10th_percentile":12001.12,"90th_percentile":12001.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2566.5,"10th_percentile":2566.5,"90th_percentile":2566.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"40","median_amount":59.34,"10th_percentile":59.34,"90th_percentile":223.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"213","median_amount":68.42,"10th_percentile":67.62,"90th_percentile":129.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"21","median_amount":117.68,"10th_percentile":83.39,"90th_percentile":237.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"85","median_amount":48.0,"10th_percentile":38.4,"90th_percentile":128.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"23","median_amount":153.78,"10th_percentile":91.9,"90th_percentile":237.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"228","median_amount":128.89,"10th_percentile":103.12,"90th_percentile":128.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":169.96,"10th_percentile":169.96,"90th_percentile":169.96},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":48.0,"10th_percentile":23.0,"90th_percentile":106.0},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"12","median_amount":69.0,"10th_percentile":68.47,"90th_percentile":148.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"28","median_amount":69.0,"10th_percentile":69.0,"90th_percentile":126.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"252","median_amount":115.21,"10th_percentile":83.39,"90th_percentile":186.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":62.1,"10th_percentile":62.1,"90th_percentile":62.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"31","median_amount":69.0,"10th_percentile":69.0,"90th_percentile":142.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"76","median_amount":58.65,"10th_percentile":58.65,"90th_percentile":221.4},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":128.89,"10th_percentile":126.55,"90th_percentile":128.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":48.0,"10th_percentile":38.47,"90th_percentile":70.0},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":274.0,"10th_percentile":274.0,"90th_percentile":274.0},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":127.35,"10th_percentile":89.69,"90th_percentile":129.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":274.0,"10th_percentile":274.0,"90th_percentile":274.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":44.85,"10th_percentile":40.36,"90th_percentile":44.85},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":69.0,"10th_percentile":69.0,"90th_percentile":69.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":204.0,"10th_percentile":204.0,"90th_percentile":204.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"18","median_amount":69.0,"10th_percentile":69.0,"90th_percentile":204.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"424","median_amount":62.1,"10th_percentile":55.89,"90th_percentile":311.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"38","median_amount":69.0,"10th_percentile":69.0,"90th_percentile":118.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"125","median_amount":67.62,"10th_percentile":54.1,"90th_percentile":103.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":86.86,"10th_percentile":86.86,"90th_percentile":86.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"639","median_amount":138.46,"10th_percentile":43.0,"90th_percentile":785.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"299","median_amount":129.47,"10th_percentile":40.27,"90th_percentile":551.93},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"65","median_amount":108.25,"10th_percentile":58.74,"90th_percentile":653.97},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"246","median_amount":104.08,"10th_percentile":16.99,"90th_percentile":275.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"378","median_amount":193.5,"10th_percentile":70.89,"90th_percentile":857.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26.72,"10th_percentile":17.96,"90th_percentile":117.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":180.4,"10th_percentile":137.87,"90th_percentile":197.8},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"465","median_amount":69.99,"10th_percentile":23.69,"90th_percentile":175.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1057","median_amount":296.16,"10th_percentile":96.17,"90th_percentile":885.7},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"140","median_amount":51.73,"10th_percentile":15.06,"90th_percentile":129.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"895","median_amount":126.0,"10th_percentile":54.6,"90th_percentile":608.3},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":78.25,"10th_percentile":25.0,"90th_percentile":115.37},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":38.75,"10th_percentile":16.94,"90th_percentile":107.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"31","median_amount":48.74,"10th_percentile":5.49,"90th_percentile":231.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"55","median_amount":110.5,"10th_percentile":67.6,"90th_percentile":742.3},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":155.32,"10th_percentile":27.5,"90th_percentile":371.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"55","median_amount":166.16,"10th_percentile":75.08,"90th_percentile":311.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"168","median_amount":144.82,"10th_percentile":68.26,"90th_percentile":232.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":78.43,"10th_percentile":78.43,"90th_percentile":120.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"5711","median_amount":139.5,"10th_percentile":30.86,"90th_percentile":835.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"561","median_amount":74.73,"10th_percentile":37.51,"90th_percentile":161.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"985","median_amount":44.62,"10th_percentile":13.58,"90th_percentile":106.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"61","median_amount":2552.43,"10th_percentile":323.36,"90th_percentile":17414.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"41","median_amount":1395.49,"10th_percentile":154.7,"90th_percentile":3397.52},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":1481.49,"10th_percentile":273.82,"90th_percentile":3437.6},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"38","median_amount":753.99,"10th_percentile":164.29,"90th_percentile":3737.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"512","median_amount":1253.77,"10th_percentile":118.44,"90th_percentile":5285.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"45","median_amount":3326.4,"10th_percentile":798.48,"90th_percentile":16808.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1115.52,"10th_percentile":1115.52,"90th_percentile":1115.52},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"120","median_amount":3767.2,"10th_percentile":899.3,"90th_percentile":11756.35},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":824.71,"10th_percentile":476.17,"90th_percentile":2415.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"138","median_amount":3665.73,"10th_percentile":389.76,"90th_percentile":13276.2},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"1 through 10","median_amount":5282.43,"10th_percentile":5282.43,"90th_percentile":5282.43},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":289.33,"10th_percentile":92.7,"90th_percentile":1740.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2402.36,"10th_percentile":821.27,"90th_percentile":3065.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2759.9,"10th_percentile":1166.75,"90th_percentile":4217.85},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1319.44,"10th_percentile":1319.44,"90th_percentile":1319.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":1742.78,"10th_percentile":1026.41,"90th_percentile":2927.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"27","median_amount":1781.16,"10th_percentile":424.65,"90th_percentile":5552.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":362.61,"10th_percentile":362.61,"90th_percentile":1073.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"712","median_amount":3888.0,"10th_percentile":476.1,"90th_percentile":14319.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"88","median_amount":1095.34,"10th_percentile":179.82,"90th_percentile":4476.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"105","median_amount":434.21,"10th_percentile":93.01,"90th_percentile":1426.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"89","median_amount":632.1,"10th_percentile":574.48,"90th_percentile":851.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"659","median_amount":458.64,"10th_percentile":432.19,"90th_percentile":617.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"103","median_amount":334.43,"10th_percentile":315.29,"90th_percentile":450.38},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":334.43,"10th_percentile":334.43,"90th_percentile":458.64},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"59","median_amount":180.05,"10th_percentile":180.05,"90th_percentile":185.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"23","median_amount":98.82,"10th_percentile":98.82,"90th_percentile":98.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"116","median_amount":98.82,"10th_percentile":94.48,"90th_percentile":98.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"51","median_amount":661.5,"10th_percentile":601.2,"90th_percentile":661.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":910.64,"10th_percentile":910.64,"90th_percentile":910.64},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"198","median_amount":624.75,"10th_percentile":624.75,"90th_percentile":841.36},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":100.82,"10th_percentile":100.82,"90th_percentile":100.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"128","median_amount":115.78,"10th_percentile":112.52,"90th_percentile":290.9},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":100.83,"10th_percentile":100.83,"90th_percentile":100.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":180.05,"10th_percentile":180.05,"90th_percentile":180.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"28","median_amount":98.82,"10th_percentile":98.82,"90th_percentile":285.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":100.83,"10th_percentile":100.83,"90th_percentile":100.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":477.75,"10th_percentile":477.75,"90th_percentile":477.75},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":334.37,"10th_percentile":334.37,"90th_percentile":334.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":334.37,"10th_percentile":334.37,"90th_percentile":334.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"23","median_amount":293.21,"10th_percentile":293.21,"90th_percentile":602.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"725","median_amount":661.5,"10th_percentile":601.2,"90th_percentile":867.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"21","median_amount":98.82,"10th_percentile":98.82,"90th_percentile":285.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"86","median_amount":100.83,"10th_percentile":100.83,"90th_percentile":103.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Durable Medical Equipment","code_information":[{"code":"N805","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":306.25,"10th_percentile":208.45,"90th_percentile":2616.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"1 through 10","median_amount":12.0,"10th_percentile":12.0,"90th_percentile":12.0},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"59","median_amount":373.97,"10th_percentile":110.45,"90th_percentile":773.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":372.07,"10th_percentile":260.16,"90th_percentile":826.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":396.31,"10th_percentile":278.92,"90th_percentile":662.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"1 through 10","median_amount":80.5,"10th_percentile":80.5,"90th_percentile":80.5},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":258.0,"10th_percentile":258.0,"90th_percentile":258.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1570.06,"10th_percentile":1570.06,"90th_percentile":1570.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":520.2,"10th_percentile":312.3,"90th_percentile":11940.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1346.04,"10th_percentile":1346.04,"90th_percentile":1346.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"14","median_amount":530.4,"10th_percentile":302.6,"90th_percentile":1683.85},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"12","median_amount":429.1,"10th_percentile":289.1,"90th_percentile":799.4},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":374.83,"10th_percentile":374.83,"90th_percentile":374.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":670.26,"10th_percentile":670.26,"90th_percentile":670.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1596.18,"10th_percentile":1596.18,"90th_percentile":1596.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":278.85,"10th_percentile":278.85,"90th_percentile":278.85},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":613.0,"10th_percentile":520.0,"90th_percentile":1731.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"52","median_amount":444.29,"10th_percentile":288.36,"90th_percentile":799.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3566.37,"10th_percentile":3566.37,"90th_percentile":3566.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":398.74,"10th_percentile":364.63,"90th_percentile":566.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":359.59,"10th_percentile":209.62,"90th_percentile":705.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"1 through 10","median_amount":508.04,"10th_percentile":414.97,"90th_percentile":723.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":192.97,"10th_percentile":131.61,"90th_percentile":272.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":1809.55,"10th_percentile":1809.55,"90th_percentile":1809.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":659.09,"10th_percentile":659.09,"90th_percentile":659.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1111.1,"10th_percentile":1111.1,"90th_percentile":1111.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":226.57,"10th_percentile":226.57,"90th_percentile":226.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":744.6,"10th_percentile":744.6,"90th_percentile":744.6},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":173.03,"10th_percentile":173.03,"90th_percentile":173.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":730.1,"10th_percentile":730.1,"90th_percentile":730.1},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":454.36,"10th_percentile":454.36,"90th_percentile":454.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1101.28,"10th_percentile":1101.28,"90th_percentile":1101.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":938.7,"10th_percentile":768.6,"90th_percentile":3715.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":629.0,"10th_percentile":606.3,"90th_percentile":761.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":89.6,"10th_percentile":89.6,"90th_percentile":110.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"16","median_amount":545.12,"10th_percentile":395.94,"90th_percentile":9019.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":518.63,"10th_percentile":402.68,"90th_percentile":801.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":147.85,"10th_percentile":147.85,"90th_percentile":147.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"14","median_amount":98.82,"10th_percentile":98.82,"90th_percentile":6032.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":796.5,"10th_percentile":796.5,"90th_percentile":796.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":332.26,"10th_percentile":332.26,"90th_percentile":332.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":599.25,"10th_percentile":599.25,"90th_percentile":752.25},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":455.11,"10th_percentile":455.11,"90th_percentile":619.5},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":90.6,"10th_percentile":90.6,"90th_percentile":90.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":172.9,"10th_percentile":172.9,"90th_percentile":172.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":98.82,"10th_percentile":98.82,"90th_percentile":98.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":221.1,"10th_percentile":221.1,"90th_percentile":221.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"18","median_amount":634.5,"10th_percentile":507.6,"90th_percentile":880.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":98.82,"10th_percentile":98.82,"90th_percentile":98.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":95.14,"10th_percentile":95.14,"90th_percentile":110.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"1 through 10","median_amount":131.92,"10th_percentile":76.12,"90th_percentile":131.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"1 through 10","median_amount":85.62,"10th_percentile":73.21,"90th_percentile":85.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":64.5,"10th_percentile":64.5,"90th_percentile":64.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"28","median_amount":99.23,"10th_percentile":84.96,"90th_percentile":146.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":76.72,"10th_percentile":43.92,"90th_percentile":102.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"1 through 10","median_amount":90.18,"10th_percentile":90.18,"90th_percentile":90.18},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":123.68,"10th_percentile":123.68,"90th_percentile":123.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"25","median_amount":59.86,"10th_percentile":46.23,"90th_percentile":65.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":143.54,"10th_percentile":47.32,"90th_percentile":167.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":49.49,"10th_percentile":49.49,"90th_percentile":272.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":42.07,"10th_percentile":42.07,"90th_percentile":42.07},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.56,"10th_percentile":175.56,"90th_percentile":175.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":101.78,"10th_percentile":92.59,"90th_percentile":193.17},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":110.51,"10th_percentile":110.51,"90th_percentile":110.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":64.28,"10th_percentile":62.85,"90th_percentile":64.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"1 through 10","median_amount":126.19,"10th_percentile":125.3,"90th_percentile":152.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"21","median_amount":82.78,"10th_percentile":32.45,"90th_percentile":114.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":64.37,"10th_percentile":59.86,"90th_percentile":64.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":100.06,"10th_percentile":61.86,"90th_percentile":100.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Advanced Medical Pricing Solutions","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 86] [Observation (%BC): 86] [Emergency Department (%BC): 86] [Reference Lab Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 86] [Physical Therapy (%BC): 86] [Respiratory Services/Therapy  (%BC): 86] [Speech Therapy (%BC): 86] [All Other OP (%BC): 86]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 45.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":62.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Traditional Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Hmo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":45.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathways Ppo Exchange","methodology":"percent of total billed charges","standard_charge_percentage":46.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":402.31,"10th_percentile":402.31,"90th_percentile":402.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Aetna Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medben","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Supermed Hmo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_percentage":77.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medigold","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 1200] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohiohealthy","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Antitode Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Non-Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quality Care Partners","plan_name":"Steered Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Urgent Care (%BC): 90] [Cardiac Rehabilitation Therapy (%BC): 90] [Cardiac Stress Test (%BC): 90] [Cardiology (%BC): 90] [Echocardiology (%BC): 90] [EKG/ECG  (%BC): 90] [Holter Monitor/Telemetry (%BC): 90] [Peripheral Vascular Lab (%BC): 90] [EEG (%BC): 90] [EMG (%BC): 90] [MEG (%BC): 90] [Neuropsychological Testing and Biofeedback (%BC): 90] [Sleep Studies (%BC): 90] [Chemotherapy (%BC): 90] [Nuclear Medicine (%BC): 90] [Oncology (%BC): 90] [Radiation Therapy  (%BC): 90] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Imaging Services (%BC): 90] [Mammography-Diagnostic (%BC): 90] [Mammography-Screening (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 90] [Ultrasound Imaging (%BC): 90] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 90] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 90] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [Ambulance--Air  (%BC): 90] [Ambulance--Land  (%BC): 90] [Hyperbarics (%BC): 90] [IV Therapy (%BC): 90] [Pulmonary Function (%BC): 90] [Pulmonary Rehabilitation (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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